Influence of Age, Health, and Function on Cancer Screening in Older Adults with Limited Life Expectancy
We examined the relationship between cancer screening and life expectancy predictors, focusing on the influence of age versus health and function, in older adults with limited life expectancy.
Longitudinal cohort study
National Health and Aging Trends Study (NHATS) with linked Medicare claims.
Three cohorts of adults 65+ enrolled in fee-for-service Medicare were constructed: women eligible for breast cancer screening (n = 2043); men eligible for prostate cancer screening (n = 1287); men and women eligible for colorectal cancer screening (n = 3759).
We assessed 10-year mortality risk using 2011 NHATS data, then used claims data to assess 2-year prostate and breast cancer screening rates and 3-year colorectal cancer screening rates. Among those with limited life expectancy (10-year mortality risk > 50%), we stratified participants at each level of predicted mortality risk and split participants in each risk stratum by the median age. We assembled two sub-groups from these strata that were matched on predicted life expectancy: a “younger sub-group” with relatively poorer health/functional status and an “older sub-group” with relatively better health/functional status. We compared screening rates between sub-groups.
For all three cancer screenings, the younger sub-groups (average ages 73.4–76.1) had higher screening rates than the older sub-groups (average ages 83.6–86.9); screening rates were 42.9% versus 34.2% for prostate cancer screening (p = 0.02), 33.6% versus 20.6% for breast cancer screening (p < 0.001), 13.1% versus 6.7% for colorectal cancer screening in women (p = 0.006), and 20.5% versus 12.1% for colorectal cancer screening in men (p = 0.002).
Among older adults with limited life expectancy, those who are relatively younger with poorer health and functional status are over-screened for cancer at higher rates than those who are older with the same predicted life expectancy.
KEY WORDSgeriatrics cancer screening health status functional status
Dr. Schoenborn had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Schoenborn, Huang, Sheehan, Wolff, Roth, Boyd. Data analysis and interpretation: Schoenborn, Huang, Sheehan, Wolff, Roth, Boyd. Preparation and review of the manuscript: Schoenborn, Huang, Sheehan, Wolff, Roth, Boyd.
This project was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by KL2TR001077 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS, or NIH. Dr. Schoenborn was also supported by a R03 from the National Institute on Aging (R03AG050912), a Cancer Control Career Development Award from the American Cancer Society (CCCDA-16-002-01) and a T. Franklin Williams Scholarship Award (funding provided by the Atlantic Philanthropies, Inc., the John A. Hartford Foundation, the Alliance for Academic Internal Medicine-Association of Specialty Professors, and the American Geriatrics Society). Dr. Boyd was supported by 1K24AG056578 from the National Institute on Aging. The funding sources had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of paper.
Compliance with Ethical Standards
This project was approved by a Johns Hopkins School of Medicine institutional review board.
Conflict of Interest
The authors declare no conflicts of interest. Dr. Cynthia Boyd received a small payment from UptoDate for having co-authored a chapter on Multimorbidity; however, we do not believe this has resulted in any conflict with the design, methodology, or results presented in this manuscript.
We have presented an earlier version of the manuscript as a poster at the 2018 Annual Beeson Scholars Meeting November 1-4, 2018 in Charlott, NC.
- 8.Ilic D, Neuberger MM, Djulbegovic M, et al. Screening for prostate cancer. Cochrane Database Syst Rev. 2013;1:CD004720.Google Scholar
- 17.Society of General Internal Medicine. Five things physicians and patients should question - the choosing wisely campaign. 2013. http://www.choosingwisely.org/wp-content/uploads/2013/09/SGIM-5things-List_091213.pdf. Accessed Sept 2014.
- 30.Montaquila J, Freedman VA, Edwards B, et al. Round 1 Sample Design and Selection. NHATS Technical Paper #1. Baltimore: Johns Hopkins University School of Public Health. 2012. Available at: https://www.nhats.org/scripts/sampling/NHATS_Round1_Sample_Design_05_10_12.pdf. Accessed 11 Aug 2017.
- 38.Kasper JD, Freedman VA, Spillman BC. Classification of persons by dementia status in the National Health and Aging Trends Study. NHATS Technical Paper #5, Baltimore: Johns Hopkins University School of Public Health. 2013. Available at: https://www.nhats.org/scripts/documents/DementiaTechnicalPaperJuly_2_4_2013_10_23_15.pdf. Accessed 1 Nov 2017.