Patient-Reported Cognitive and Functional Impairments Among Older Canadians With Cancer: a Population-Based Study

Cancer is estimated to affect one out of two Canadians throughout their lifetime and to be the cause of death of one out of four Canadians. Although it can affect virtually patients of any age, it disproportionately affects older adults.

The objective of the present study is to assess the prevalence of self-reported cognitive and functional impairments among older adults with cancer vs. older adults without cancer; and to evaluate the factors associated with self-reported cognitive impairment among older adults with cancer.

Canadian Community Health Survey data sets (2007-2016) were accessed, and participants 65 years wand older who answered the question Do you have cancer? and who have complete information about participant-reported cognitive function (assessed through health utilities index) were included. Differences in participant-reported functional status (including cognition, vision, hearing, speech, ambulation, dexterity, and emotion) between older adults with or without cancer were evaluated through Chi-squared testing. Multivariable logistic regression analysis was conducted to assess factors associated with participant-reported cognitive impairment among older adults with cancer.

A total of 73,110 participants 65 years and older were included: 4342 participants with an active cancer diagnosis and 68,768 participants without an active cancer diagnosis (at the time of survey completion). Participants with cancer were more likely to report impairment in cognition (participants with cancer who can remember and think: 62.3%, whereas participants without cancer who can remember and think: 67.3%; P < 0.001), hearing (participants with cancer who can hear well: 82.2%, whereas participants without cancer who can hear well: 86.7%; P < 0.001), and mobility (participants with cancer who can walk without difficulty: 77.3%, whereas participants without cancer who can walk without difficulty: 84%; P < 0.001). The following factors were associated with participant-reported cognitive impairment among older adults with cancer: older age (odds ratio [OR] for age 65-69 years vs. age 80 years and older: 0.54; 95% CI: 0.35-0.84), lower income (OR: 2.12; 95% CI: 1.14-3.92), poor self-perceived health (OR for excellent vs. poor health: 0.38; 95% CI: 0.17-0.81), poor self-perceived mental health (OR for excellent vs. poor health: 0.08; 95% CI: 0.02-0.28), and illicit drug use (OR: 2.04; 95% CI: 1.31-3.18).

Older adults with an active cancer diagnosis are more likely to report impaired cognitive and functional status compared with older adults without an active cancer diagnosis. More efforts are needed to ensure the integration of validated geriatric assessment tools (incorporating patient-reported elements) in the care of older adults with cancer.