Anemia and functional disability in older adults with cancer.

Abstract

9109 Background: While anemia is associated with functional disability in older adults in general, this relationship has not been well characterized in older adults with cancer. We sought to examine the association between anemia and functional disability and to identify other factors associated with functional disability in patients (pts) age ≥65 with cancer. Methods: We conducted a secondary analysis of a multi-center prospective study of 500 pts ≥ age 65 that identified predictors of chemotherapy (chemo) toxicity (Hurria et al, JCO, 2011). The primary outcome of this analysis was functional disability, defined as need for assistance with ≥1 instrumental activities of daily living. Data collected prior to initiation of a new chemo regimen included: age, tumor/treatment variables, labs [including hemoglobin (Hb)], and geriatric assessment (functional status, comorbidity, social support, psychological, cognitive, and nutritional status). Anemia (World Health Organization criteria) was defined as Hb <12g/dl (women) and Hb <13g/dl (men). Bivariate analysis and logistic regression were used to examine the association between functional disability, anemia, and other pre-treatment variables. Results: Among 500 pts [median age 72 years (range 65-91), 56% female, 61% stage IV], the prevalence of functional disability and anemia was 43% and 51%, respectively. The mean Hb was 11.7g/dl and 12.6g/dl among pts with and without functional disability. Pts with anemia were more likely to report functional disability (53% vs. 46%, p<0.01). On multivariate analysis, factors associated with functional disability included anemia [Odds Ratio (OR)= 2.06, 95% confidence interval (CI)= 1.39-3.05], increased age (OR= 1.04, 95% CI = 1.00-1.07), increased comorbidity (OR= 1.23, 95% CI = 1.09-1.39), advanced stage (OR= 1.85, 95% CI = 1.22-2.80), and unintentional weight loss (OR= 2.02, 95% CI = 1.37-3.00). Conclusions: Anemia was highly prevalent and was associated with functional disability. Prospective studies that further examine the relationship between anemia and functional disability and randomized-controlled trials that evaluate the correction of anemia as a modifiable strategy to improve functional status in older pts with cancer are warranted.