Christopher Edward Jensen, Tzy-Mey Kuo, Matthew R LeBlanc, Christopher D Baggett, Emilie D Duchesneau, Xi Zhou, Katherine E Reeder-Hayes, Jennifer L Lund
{"title":"新诊断为多发性骨髓瘤的老年人的功能状态与接受治疗和治疗结果的关系。","authors":"Christopher Edward Jensen, Tzy-Mey Kuo, Matthew R LeBlanc, Christopher D Baggett, Emilie D Duchesneau, Xi Zhou, Katherine E Reeder-Hayes, Jennifer L Lund","doi":"10.1200/CCI.23.00214","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Multiple myeloma (MM) is a prevalent hematologic malignancy in older adults, who often experience physical disability, increased health care usage, and reduced treatment tolerance. Home health (HH) services are frequently used by this group, but the relationship between disability, HH use, and MM treatment receipt is unclear. This study examines the connections between disability, treatment receipt, and survival outcomes in older adults with newly diagnosed MM using a nationwide data set.</p><p><strong>Methods: </strong>The SEER-Medicare data set was used to identify adults aged 66 years and older diagnosed with MM from 2010 to 2017, who used HH services the year before diagnosis. Disability was assessed with the Outcome and Assessment Information Set, using a composite score derived from items related to ability to complete activities of daily living. Mortality, therapy receipt, and health care utilization patterns were evaluated.</p><p><strong>Results: </strong>Of 37,280 older adults with MM, 6,850 (18.2%) used HH services before diagnosis. Moderate disability at HH assessment resulted in similar MM-directed therapy receipt as mild disability, with comparable health care usage after diagnosis to severe disability. HH users had a higher comorbidity burden and higher mortality (adjusted risk ratio for 3-year mortality: 1.59 [95% CI, 1.55 to 1.64]). Severe functional disability before diagnosis was strongly related to postdiagnosis mortality.</p><p><strong>Conclusion: </strong>Among older adults with MM receiving HH services, disability is a predictor of early mortality. Moderately disabled individuals undergo similar therapy intensity as the mildly disabled but experience increased acute care utilization. Previous HH use could identify patients with MM requiring intensive support during therapy initiation.</p>","PeriodicalId":51626,"journal":{"name":"JCO Clinical Cancer Informatics","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10861012/pdf/","citationCount":"0","resultStr":"{\"title\":\"Functional Status Associations With Treatment Receipt and Outcomes Among Older Adults Newly Diagnosed With Multiple Myeloma.\",\"authors\":\"Christopher Edward Jensen, Tzy-Mey Kuo, Matthew R LeBlanc, Christopher D Baggett, Emilie D Duchesneau, Xi Zhou, Katherine E Reeder-Hayes, Jennifer L Lund\",\"doi\":\"10.1200/CCI.23.00214\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Multiple myeloma (MM) is a prevalent hematologic malignancy in older adults, who often experience physical disability, increased health care usage, and reduced treatment tolerance. Home health (HH) services are frequently used by this group, but the relationship between disability, HH use, and MM treatment receipt is unclear. This study examines the connections between disability, treatment receipt, and survival outcomes in older adults with newly diagnosed MM using a nationwide data set.</p><p><strong>Methods: </strong>The SEER-Medicare data set was used to identify adults aged 66 years and older diagnosed with MM from 2010 to 2017, who used HH services the year before diagnosis. Disability was assessed with the Outcome and Assessment Information Set, using a composite score derived from items related to ability to complete activities of daily living. Mortality, therapy receipt, and health care utilization patterns were evaluated.</p><p><strong>Results: </strong>Of 37,280 older adults with MM, 6,850 (18.2%) used HH services before diagnosis. Moderate disability at HH assessment resulted in similar MM-directed therapy receipt as mild disability, with comparable health care usage after diagnosis to severe disability. HH users had a higher comorbidity burden and higher mortality (adjusted risk ratio for 3-year mortality: 1.59 [95% CI, 1.55 to 1.64]). Severe functional disability before diagnosis was strongly related to postdiagnosis mortality.</p><p><strong>Conclusion: </strong>Among older adults with MM receiving HH services, disability is a predictor of early mortality. Moderately disabled individuals undergo similar therapy intensity as the mildly disabled but experience increased acute care utilization. Previous HH use could identify patients with MM requiring intensive support during therapy initiation.</p>\",\"PeriodicalId\":51626,\"journal\":{\"name\":\"JCO Clinical Cancer Informatics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10861012/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JCO Clinical Cancer Informatics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1200/CCI.23.00214\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JCO Clinical Cancer Informatics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1200/CCI.23.00214","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:多发性骨髓瘤(MM)是一种普遍存在于老年人中的血液系统恶性肿瘤,老年人通常会出现肢体残疾、医疗保健使用增加以及治疗耐受性降低等问题。这一群体经常使用家庭保健(HH)服务,但残疾、使用家庭保健和接受多发性骨髓瘤治疗之间的关系尚不清楚。本研究利用全国范围内的数据集研究了新诊断为 MM 的老年人的残疾、接受治疗和生存结果之间的关系:方法:使用 SEER-Medicare 数据集来识别 2010 年至 2017 年期间确诊为 MM 的 66 岁及以上成年人,他们在确诊前一年使用过 HH 服务。残疾通过 "结果与评估信息集"(Outcome and Assessment Information Set)进行评估,该信息集采用了由完成日常生活活动能力相关项目得出的综合评分。对死亡率、接受治疗情况和医疗保健使用模式进行了评估:在 37280 名患有 MM 的老年人中,有 6850 人(18.2%)在确诊前使用过保健服务。在接受保健院评估时,中度残疾与轻度残疾接受 MM 指导治疗的情况相似,确诊后使用保健服务的情况与重度残疾相似。保健院使用者的合并症负担较重,死亡率较高(调整后的 3 年死亡率风险比:1.59 [95% CI,1.55 至 1.64])。诊断前的严重功能障碍与诊断后的死亡率密切相关:结论:在接受 HH 服务的 MM 患者中,残疾是早期死亡率的预测因素。中度残疾者接受的治疗强度与轻度残疾者相似,但急症护理的使用率增加。以前使用过保健服务的 MM 患者在开始治疗时需要强化支持,而以前使用过保健服务的患者可以识别出这些患者。
Functional Status Associations With Treatment Receipt and Outcomes Among Older Adults Newly Diagnosed With Multiple Myeloma.
Purpose: Multiple myeloma (MM) is a prevalent hematologic malignancy in older adults, who often experience physical disability, increased health care usage, and reduced treatment tolerance. Home health (HH) services are frequently used by this group, but the relationship between disability, HH use, and MM treatment receipt is unclear. This study examines the connections between disability, treatment receipt, and survival outcomes in older adults with newly diagnosed MM using a nationwide data set.
Methods: The SEER-Medicare data set was used to identify adults aged 66 years and older diagnosed with MM from 2010 to 2017, who used HH services the year before diagnosis. Disability was assessed with the Outcome and Assessment Information Set, using a composite score derived from items related to ability to complete activities of daily living. Mortality, therapy receipt, and health care utilization patterns were evaluated.
Results: Of 37,280 older adults with MM, 6,850 (18.2%) used HH services before diagnosis. Moderate disability at HH assessment resulted in similar MM-directed therapy receipt as mild disability, with comparable health care usage after diagnosis to severe disability. HH users had a higher comorbidity burden and higher mortality (adjusted risk ratio for 3-year mortality: 1.59 [95% CI, 1.55 to 1.64]). Severe functional disability before diagnosis was strongly related to postdiagnosis mortality.
Conclusion: Among older adults with MM receiving HH services, disability is a predictor of early mortality. Moderately disabled individuals undergo similar therapy intensity as the mildly disabled but experience increased acute care utilization. Previous HH use could identify patients with MM requiring intensive support during therapy initiation.