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KLIMOP: a cohort study on the wellbeing of older cancer patients

KLIMOP: a cohort study on the wellbeing of older cancer patients. Laura Deckx

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KLIMOP: a cohort study on the wellbeing of older cancer patients

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  1. KLIMOP: a cohort study on the wellbeing of older cancer patients Laura Deckx Liesbeth Daniels, Katherine Nelissen, Piet Stinissen, Paul Bulens, Loes Linsen, Jean-Luc Rummens, Doris van Abbema,Franchette van den Berkmortel, Hans Wildiers, Vivianne C. Tjan-Heijnen, Marjan van den Akker, Frank Buntinx

  2. Klimop • Klimop was conceptualised by Prof. Buntinx and Dr. Bulens after a study performed by LIKAS in 2007 among stakeholders • “Cancer in Limburg: Challenges and strategic options for a coordinated approach “ • This study showed that the challenges in cancer care will be: • The psychosocial aspects of cancer care • Scientific research for older cancer patients

  3. Survival: quantity or quality? • Survival: quantity • Survival of cancer patients increases • Not for older cancer patients: EUROCARE project (Quaglia 2009) • Survival: quality • The fear to loose autonomy > the fear to die (Jolly 2006) • Macmillan Listening Study: To study the impact of cancer on everyday life was defined as the top priority area for cancer research (Okamoto 2011)

  4. Klimop-study To assess the impact of cancer, ageing and their interaction on subsequent wellbeing of older cancer patients

  5. Inclusion (January 2011)

  6. Comorbidity • Comorbidity: the co-occurence of different diseases • Comorbidity is an enormous problem (Marengoni 2011) • Highly prevalent (55% - 98%) • Cause of disability, functional impairment, low Qol, high health care costs • Survival

  7. Comorbidity Guidelines to for the treatment of cancer patients with comorbidity are lacking! (SignaleringscommissieKanker van KWF Kankerbestrijding 2011)

  8. Functional status • Maintenance of independence is very important • Associated with survival • Cancer patients have more functional problems (Hewitt 2003, Keating 2005) • Little prospective studies that investigate the risk factors for functional decline in older cancer patients → Cave! Selection of participants

  9. Functional status* :Baseline ~ 6 months *Functional status (ADL en IADL): Computed as described by Kellen et al. 2010

  10. Baseline Functional status* ~ Loneliness *Functional status (ADL en IADL): Computed as described by Kellen et al. 2010

  11. Depression • Depression is important: • Leading cause of disability worldwide • Commonly coexists • Predicts overall survival (Kanesvaran 2011 JCO) • Depression decreased – overall survival increased! (Giese-Davis 2011 JCO) • Results are inconclusive

  12. Depression:Baseline ~ 6 months

  13. Baseline Depression ~ Loneliness

  14. Quality of life • What is the impact of cancer, cancer treatment, ageing and their interaction on Qol? • Results are inconclusive • Methodological shortcomings (Joly 2007) • Cross-sectional • Presentation of mean values! • Prospective but Qol measured only once • Selection of patients

  15. Global Qol:Baseline ~ 6 months

  16. Wellbeing • Little is known about the interaction between the co-occurrence of • Comorbidity • Functional impairment • Geriatric syndromes • (Koroukian 2011 JCO)

  17. Preliminary conclusions • Results are preliminary and cross-sectional! The longer the duration of the study, the more valuable the results will be • Loneliness and depression are frequent and important factors that can be influenced • Guidelines for care of cancer patients with multimorbidity are needed, taking into account: • Co-morbidity/functional impairment/… • Consequences of cancer treatment • Collaboration between different disciplines in primary and secondary care

  18. Take home message • Be critical! • Was the study population appropriate? • Cross-sectional design versus prospective design? • Older cancer patients • Heterogeneous group • Specific health care needs • Quality rather than quantity of survival • Which factors determine maintenance or decline of wellbeing? “Knowing is not enough; we must apply. Willing is not enough; we must do.” Goethe

  19. Laura.deckx@med.kuleuven.beKatherine.nelissen@uhasselt.be Doris.van.abbema@mumc.nl KLIMOP is funded by VLK, the Flemisch League against Cancer and Interreg IV cross-border region Flanders – the Netherlands Contact: www.ouderenenkanker.be Deckx L, Van Abbema D, Nelissen K, Daniels L, Stinissen P, Bulens P, Linsen L, Rummens JL, Van den Berkmortel F, Robaeys G, De Jonge E, Houben B, Pat K, Walgraeve D, Spaas L, Verheezen J, Verniest T, Goegebuer A, Wildiers H, Tjan-Heijnen V, Buntinx F, Van den Akker M. Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands. BMC Publ Health 2011; 11: 825

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