Effect of fractures on overall survival in cancer patients: The NHANES database.

Abstract

e23024 Background: Fractures are a significant cause of morbidity, institutionalization and mortality in older adults who are cancer-free. We evaluated the effect of fractures on overall survival in older patients with cancer. Methods: The National Health and Nutrition Study (NHANES) assessed the health and nutritional status of the U.S. The NHANES database is publicly available, and this study was exempt from approval by an institutional review board. All participants provided informed consents both before the interview and examination stages. A total of 62,160 individuals participated in NHANES during 1999-2010. We restricted our analyses to older adults (65 years of age and older) with self-reported cancer diagnosis, with a follow-up till 2011. Results: In total, 1,718 older adults with cancer and with available follow up were included for final analysis. There were 303 participants with fractures (17.6%) and 581 deaths (33.8%) that occurred over a median follow up 4.3 years (range 0.1-12.8 years). Mean age was 74.8 ± 0.2, with females 49.6%. Cancer types included solid tumors and hematologic malignancies. Among solid tumors, colorectal 9.0%, breast cancer 17.4%, prostate cancer 17.7%, lung 3.0%. Among hematologic malignancies, lymphoma 1.6%, myeloma 7.2%, CLL 1.2%. Hip fractures were associated with advanced age, obesity, diabetes, stroke, functional impairment, and mortality. Spine fractures were associated with advanced age, cardiovascular disease, functional impairment and mortality. Univariate analysis for factors associated with overall survival in older adults in NHANES revealed an increased risk with spine fractures H.R. = 1.89, (95% CI 1.11, 3.2, p = 0.02) and hip fractures H.R. = 2.66, (95% CI 1.41, 5.02, p < 0.01). Conclusions: In older cancer patients vertebral and hip fractures were associated with an increased risk for mortality.