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J Gen Intern Med. 2019 Jan;34(1):110-117. doi: 10.1007/s11606-018-4717-y. Epub 2018 Nov 6.

Influence of Age, Health, and Function on Cancer Screening in Older Adults with Limited Life Expectancy.

Author information

1
The Johns Hopkins School of Medicine, Baltimore, MD, USA. nancyli@jhmi.edu.
2
The Johns Hopkins Center on Aging and Health, Baltimore, MD, USA. nancyli@jhmi.edu.
3
The Johns Hopkins School of Medicine, Baltimore, MD, USA.
4
The Johns Hopkins Center on Aging and Health, Baltimore, MD, USA.
5
The Johns Hopkins School of Public Health, Baltimore, MD, USA.

Abstract

BACKGROUND/OBJECTIVES:

We examined the relationship between cancer screening and life expectancy predictors, focusing on the influence of age versus health and function, in older adults with limited life expectancy.

DESIGN:

Longitudinal cohort study SETTING: National Health and Aging Trends Study (NHATS) with linked Medicare claims.

PARTICIPANTS:

Three cohorts of adults 65+ enrolled in fee-for-service Medicare were constructed: women eligible for breast cancer screening (n = 2043); men eligible for prostate cancer screening (n = 1287); men and women eligible for colorectal cancer screening (n = 3759).

MEASUREMENTS:

We assessed 10-year mortality risk using 2011 NHATS data, then used claims data to assess 2-year prostate and breast cancer screening rates and 3-year colorectal cancer screening rates. Among those with limited life expectancy (10-year mortality risk > 50%), we stratified participants at each level of predicted mortality risk and split participants in each risk stratum by the median age. We assembled two sub-groups from these strata that were matched on predicted life expectancy: a "younger sub-group" with relatively poorer health/functional status and an "older sub-group" with relatively better health/functional status. We compared screening rates between sub-groups.

RESULTS:

For all three cancer screenings, the younger sub-groups (average ages 73.4-76.1) had higher screening rates than the older sub-groups (average ages 83.6-86.9); screening rates were 42.9% versus 34.2% for prostate cancer screening (p = 0.02), 33.6% versus 20.6% for breast cancer screening (p < 0.001), 13.1% versus 6.7% for colorectal cancer screening in women (p = 0.006), and 20.5% versus 12.1% for colorectal cancer screening in men (p = 0.002).

CONCLUSION:

Among older adults with limited life expectancy, those who are relatively younger with poorer health and functional status are over-screened for cancer at higher rates than those who are older with the same predicted life expectancy.

KEYWORDS:

cancer screening; functional status; geriatrics; health status

PMID:
30402822
PMCID:
PMC6318172
[Available on 2020-01-01]
DOI:
10.1007/s11606-018-4717-y

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