Oral Presentation NSW State Cancer Conference 2023

Understanding the impact of physical comorbidities on treatment commencement and completion, and quality of life, among older cancer patients in a rural Australian setting  (#23)

Mathew George 1 , Alexandra Smith 1 , Geetha Ranmuthugala 2 , Srinivas Kondalsamy-Chennakesavan 3 , Sabe Sabesan 4 5
  1. North West Cancer Centre, Tamworth Hospital, Hunter New England Health, Tamworth, NSW, Australia
  2. School of Rural Medicine, University of New England, Armidale, NSW, Australia
  3. Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
  4. Statewide Regional Clinical Trial Coordinating Centre (RCCC), Health Innovation, Investment & Research Office, Queensland Health, Townsville, Queensland, Australia
  5. Department of Medical Oncology, Townsville Cancer Centre, Queensland Health, Townsville, Queensland, Australia

Aim: This paper presents findings from a mixed methods study focused on understanding the impact of physical comorbidity on treatment commencement and completion, and health-related quality of life, in a specific rural cohort of oncology patients aged >65 years.

Methods: The study employed quantitative and qualitative research methods to determine the impact of comorbidities in treating geriatric oncology patients:

  • Quantitative data was obtained using standardized questionnaires and assessment tools to gather information regarding patients’ sociodemographic details, cancer diagnosis, treatment access, commencement and completion, and quality of life (QoL). Descriptive analysis was undertaken to understand participant characteristics, rurality, and cancer-related details at baseline using frequencies and cross-tabulations; and further analysis was undertaken to examine the relationship between comorbidity and cancer outcome; and comorbidity and QoL.
  • The qualitative component of the study adopted an approach comprising Focus Group Discussions to gather in-depth information and perspectives from patients, caregivers, and health professionals on the barriers and challenges faced in accessing cancer treatment in a rural context.

Results: Participants in the focus groups identified travel to larger regional centres and/or metropolitan areas and related arrangements as primary challenges to accessing diagnostic tests, surgeries, some treatments, and follow-up tests. Quantitative analysis revealed that the majority of the study population reported 2-6 comorbidities and COPD was the most prevalent comorbidity. An overall reduction in QoL was observed on comparison between QoL at baseline and post- cycle 4 of treatment. Patients with higher comorbidity burden experienced a greater negative impact on their QoL following 4 cycles of cancer treatment. Examination of the relationship between comorbidity and cancer outcome revealed disease progression in patients with higher comorbidity burden than those with lower comorbidity burden. For the association between comorbidity and different treatment choice the results showed that having comorbidity and higher comorbidity burden was associated with increased possibility of receiving palliative (rather than curative) treatment.

Discussion & Conclusion: Presence of comorbidities can play a role in treatment decisions and thus may have a negative prognostic impact, which is evident from the results of the study. The study concluded that higher comorbidity burden could be considered a strong predictor of poor cancer outcomes and reduced HRQOL in a rurally-located geriatric population. study suggests the need for frequent monitoring and screening of geriatric cancer patients, to enhance outcomes of treatment and contribute to improvement of HRQoL in geriatric cancer patients living in rural and regional locations.