Many nursing home residents do not receive cancer-directed treatment, and they are even less likely to do so if they have a self-care disability, according to a new study.
The findings may reflect an emerging understanding that some cancer therapies are not beneficial to older, frail adults — and suggest that functional status could be used to inform goals-of-care discussions for elders with cancer, the authors said.
The researchers analyzed health data from the Minimum Data Set and Medicare between 2011 and 2015. They found a strong link between receipt of systemic (drug-related) cancer therapies for residents with advanced non-small cell lung cancer and disability in dressing, toileting, personal hygiene, locomotion and bed mobility.
In fact, most residents with this cancer diagnosis had at least one disability, and only 13% received either chemotherapy alone or with immunotherapy — independent of clinical characteristics, reported corresponding author Orestis A. Panagiotou, M.D., Ph.D., and colleagues. What’s more, the greater the loss of function, the lower the likelihood a resident would be prescribed cancer treatments, he and his colleagues wrote.
“Taken together, these results possibly reflect a growing recognition among clinicians of the little benefit of chemotherapy in patients with poor performance status and functional limitations,” they said.
But there was another revelation: Residents without self-care disabilities also had low levels of cancer-directed treatment, added Panagiotou, of the Brown University School of Public Health. Functional status may therefore be a useful measure with which to identify residents who may be better helped by, and are eligible for, cancer treatment, Panagiotou concluded.
The study was published online ahead of print in the Journal of Geriatric Oncology.