Survival predictors of older cancer patients in Bangladesh: A multicenter study

The aging of the global population has led to an increased prevalence of cancer among older adults, particularly in Asia and in low- and middle-income countries. This demographic shift presents unique challenges to healthcare delivery, especially in developing countries like Bangladesh. This study aims to analyze survival outcomes and epidemiological patterns of elderly cancer patients in Bangladesh, addressing a critical knowledge gap in geriatric oncology in low- and middle-income countries METHODS: A 27-month prospective cohort study, conducted from October 2021 to January 2024 across three hospitals in Bangladesh, included 862 cancer patients aged 60 and older, 581 of whom completed the full study period. Demographic data, medical history, physical status, and treatment records were collected through questionnaires and follow-up. Survival analysis was performed using the Kaplan-Meier method and Cox proportional hazards regression models.

Of 581 patients with a mean age of 65.9 years, 67.47 % died during the study. Lung cancer was the most common diagnosis (43.5 %), while breast cancer patients had the highest survival rate of the cohort (56.61 %). Mortality risk slightly increased with age (HR 1.02, 95 % CI:1.01, 1.04, p = 0.04), while sex had no significant impact. Advanced stage cancer increased mortality risk (HR 1.67, 95 % CI:1.10, 2.54, p = 0.01), while adequate food intake (HR 0.47, 95 % CI:0.31, 0.72, p = 0.00), better mobility (HR 0.62, 95 % CI: 0.40, 0.94, p = 0.02), and positive health perception (HR 0.54, 95 % CI:0.38,0.75, p = 0.00), were linked to improved survival. Treatment with more than two drugs alongside platinum-based chemotherapy increased mortality (HR 2.03, 95 % CI:1.14, 3.63, p = 0.01) compared to non-platinum or oral drugs, while a history of post-diagnosis surgery was associated with reduced mortality. Comorbidities and BMI were not significant in the multivariate analysis.

The study underscores the need for comprehensive, individualized care plans for older cancer patients, considering both the type of cancer and the patient's overall health. Future research should focus on optimizing treatment strategies and care models tailored to older cancer patients in resource-limited settings.