Geriatric impairments were directly and indirectly associated with mortality in older patients with cancer: a structural equation analysis

• Published in: Journal of clinical epidemiology Vol. 148; pp. 17 - 26
• Main Authors: Canouï-Poitrine, Florence, Martinez-Tapia, Claudia, Paillaud, Elena, Mathoulin-Pelissier, Simone, Pamoukdjian, Frédéric, Frasca, Matthieu, Tolppanen, Anna-Maija, Bringuier, Michael, Brain, Etienne, Broussier, Amaury, Bastuji-Garin, Sylvie, Laurent, Marie, Audureau, Etienne
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2022; Elsevier Limited; Elsevier
• Subjects: Breast cancer; Cancer; Cognition; Cognition & reasoning; Cognitive ability; Comorbidity; Direct and indirect effects; Domains; Epidemiology; Gastrointestinal tract; Geriatric assessment; Geriatrics; Impairment; Interrelationships; Life Sciences; Metastases; Mortality; Multivariate statistical analysis; Nutrition; Nutritional status; Older people; Patients; Prostate; Santé publique et épidémiologie; Social interactions; Structural equation modeling; Structural equation modelling; Survival; Urinary tract; France; Interrelationships; Geriatric assessment; Direct and indirect effects; Structural equation modelling; Survival; Cancer
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2022.04.004

We assessed the direct and indirect effects between six geriatric domains and 6- and 12-month mortality in older cancer patients.
We included cancer patients aged ≥70 years from the Elderly Cancer Patients cohort, referred for geriatric assessment between 2007 and 2016. We used structural equation modelling to examine the interrelationships between six geriatric domains (function and mobility, nutrition, cognition, mood, comorbidities and polypharmacy, and social support) and the direct and indirect relationships between these domains, the cancer stage, site, and treatment on the one hand and mortality on the other.
The analysis included 1,434 patients (mean age: 80 ± 5.6 years; women: 48%; main cancer sites: digestive tract [36.2%], urinary tract and prostate [26.6%], and breast [16.5%]; metastatic cancer: 48%). Direct relationships to 6- and 12-month mortality were identified for functional impairment (standardized coefficient [SC]: 0.37 [P < 0.001] and 0.32 [P < 0.001], respectively), poor nutritional status (SC: 0.11 [P = 0.005] and 0.14 [P = 0.001]), poor social support (SC = 0.07 [P = 0.08] and 0.09 [P = 0.02]), cancer site, stage, and treatment. The effects of comorbidities, cognitive impairment, and depression on mortality were mediated by functional and nutritional status.
In older cancer patients, functional and nutritional impairments were the strongest direct prognostic geriatric factors for mortality.