Patient-reported psychosocial needs and psychological distress predict survival in geriatric oncology patients

Little is known about how psychosocial factors and distress affect older patients with cancer and their survival. The study goals were to: 1) observe the prevalence of anxiety (ANX) and depression (DEP) symptoms at diagnosis in patients aged ≥65 years, 2) observe the association between social isolation (isolation) and distress, and 3) evaluate the impact on overall survival (OS).

A retrospective cohort study was completed for all patients ≥65 years (N = 25,382) referred to the provincial cancer care program in British Columbia, Canada from 2011 to 2016. Patients who completed the Psychosocial Screen for Cancer within 6 months of diagnosis were included. Baseline and disease characteristics were collected retrospectively.

Subclinical/clinical levels of ANX and DEP were found in 32% and 23%, respectively. Thirty-six percent of patients reported at least one indicator for isolation. Factors associated with distress at presentation included female, age 65-69, lung cancer, metastatic disease, and presence of any risk indicator for isolation (p-values <0.001). Patients with any risk indicator for isolation had higher rates of subclinical/clinical levels of ANX and DEP. On multivariate analysis including age, sex and stage, hazard ratio (HR) for death was increased with ANX (1.30), DEP (1.51) and isolation (1.12) (p < 0.001).

Older adults with cancer with symptoms of distress are more likely to be female, aged 65-69, socially isolated, have metastatic disease or have lung cancer. ANX, DEP, and isolation are independent negative prognostic variables for OS. This vulnerable population should receive psychological support to improve outcomes.