Serious Health-Related Suffering Impairs Treatments and Survival in Older Patients With Cancer

Matthieu Frasca; Claudia Martinez-Tapia; Charline Jean; Alex Chanteclair; Angeline Galvin; Valérie Bergua; Meoïn Hagege; Philippe Caillet; Marie Laurent; Etienne Brain; Simone Mathoulin-Pélissier; Elena Paillaud; Florence Canoui-Poitrine

doi:10.1016/j.jpainsymman.2024.08.002

Serious Health-Related Suffering Impairs Treatments and Survival in Older Patients With Cancer

J Pain Symptom Manage. 2024 Nov;68(5):506-515.e5. doi: 10.1016/j.jpainsymman.2024.08.002. Epub 2024 Aug 13.

Affiliations

¹ EPICENE team, U1219 Bordeaux Population Health Research Center (M.F., A.C., A.G., S.M.P.), University of Bordeaux, Bordeaux, France; Palliative Medicine Department (M.F., A.C.), CHU of Bordeaux, Talence, France; CEpiA team, U955 IMRB (M.F., C.M.T., C.J., M.H., P.C., M.L., E.P., F.C.P.), University Paris Est Créteil, Créteil, France. Electronic address: matthieu.frasca@chu-bordeaux.fr.
² CEpiA team, U955 IMRB (M.F., C.M.T., C.J., M.H., P.C., M.L., E.P., F.C.P.), University Paris Est Créteil, Créteil, France.
³ CEpiA team, U955 IMRB (M.F., C.M.T., C.J., M.H., P.C., M.L., E.P., F.C.P.), University Paris Est Créteil, Créteil, France; Public Health Department & URC (C.J., F.C.P.), APHP, Henri-Mondor Hospital, Creteil, France.
⁴ EPICENE team, U1219 Bordeaux Population Health Research Center (M.F., A.C., A.G., S.M.P.), University of Bordeaux, Bordeaux, France; Palliative Medicine Department (M.F., A.C.), CHU of Bordeaux, Talence, France.
⁵ EPICENE team, U1219 Bordeaux Population Health Research Center (M.F., A.C., A.G., S.M.P.), University of Bordeaux, Bordeaux, France.
⁶ ACTIVE team, U1219 Bordeaux Population Health Research Center (V.B.), University of Bordeaux, Bordeaux, France.
⁷ Oncology Department (E.B.), Curie Institute, Paris, France.
⁸ EPICENE team, U1219 Bordeaux Population Health Research Center (M.F., A.C., A.G., S.M.P.), University of Bordeaux, Bordeaux, France; Epidemiological and Clinical Research Unit (S.M.P.), Bergonie Institute, Bordeaux, France.

PMID: 39142494
DOI: 10.1016/j.jpainsymman.2024.08.002

Abstract

Context: More than half of new cancer cases occurred in older adults. Older patients with cancer are particularly at risk of physical, psycho-existential or socio-familial suffering as defined by the concept of Serious Health-related Suffering (SHS).

Objectives: To assess the direct and indirect effects of physical, psycho-existential and socio-familial dimensions of suffering on cancer treatability, supportive care needs and 12-month mortality in older patients with cancer.

Methods: We included patients with cancer aged 70 years and over from the Elderly Cancer Patients cohort (ELCAPA, Ile-de-France), referred for geriatric assessment between 2007 and 2019 before cancer treatment. Structural equation modelling examined the direct and indirect relationships between SHS dimensions (latent variables), patients' characteristics (age, sex, tumor location and metastatic status, comorbidity, period of care), and outcomes.

Results: The analysis included 4,824 patients (mean age: 82.2 ± 4 years; women: 56%; main cancer sites: breast [22.3%], colorectal [15.2%], prostate [8.5%], and lung [6.8%]; metastatic cancer: 46%). Physical suffering had direct pejorative effects on cancer treatability, and mortality (standardized coefficient [SC] = 0.12 [P < 0.001], SC = 0.27 [P < 0.001], respectively). Psycho-existential and socio-familial sufferings had indirect pejorative effects on survival through decreased cancer treatability (SC = 0.08 [P < 0.001], SC = 0.03 [P < 0.001], respectively). Psycho-existential dimension had the main direct effect size on supportive care needs (SC = 0.35 [P < 0.001]) and was interrelated with physical suffering.

Conclusion: Physical suffering has direct pejorative effect on survival. All dimensions indirectly decrease survival due to poorer cancer treatability. Our findings support concomitant management of physical and psycho-existential suffering.

Keywords: Cancer; Mortality; Older; Serious health-related suffering; Structural equation modelling; Supportive care.

MeSH terms

Aged
Aged, 80 and over
Female
France
Geriatric Assessment
Humans
Male
Neoplasms* / mortality
Neoplasms* / psychology
Neoplasms* / therapy
Stress, Psychological