Medicare Health Outcomes Survey Research Articles

Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep

ObjectiveTo examine mediating effects of sleep quality and duration on the association between T2D and QoL among Medicare beneficiaries 65+. MethodsData from the Medicare Health Outcome Survey (2015–2020) were used. The outcome was QoL (physical and mental health component-summary scores [PCS and MCS]) measured by the Veterans-Rand-12. The main predictor was diagnosed T2D. Mediators were sleep duration and sleep quality. The effect modifier was race/ethnicity. Structural Equation Modeling was used to estimate moderated-mediating effects of sleep quality and duration across race/ethnicity. ResultsOf the 746,400 Medicare beneficiaries, 26.7% had T2D, and mean age was 76 years (SD ± 6.9). Mean PCS score was 40 (SD ± 12.2), and mean MCS score was 54.0 (SD ± 10.2). Associations of T2D with PCS and MCS were negative and significant. For all racial/ethnic groups, those with T2D reported lower PCS. For White, Black, Asian, and Hispanic beneficiaries only, those with T2D reported lower MCS. The negative impact of T2D on PCS and MCS was mediated through sleep quality, especially very bad sleep quality. ConclusionImproving sleep may lead to improvement in QoL in elderly adults with T2D.

Do Contemporary Cancer Survivors Experience Better Quality of Life? Evaluating a Decade of SEER Medicare Health Outcomes Survey Data.

A cancer diagnosis may have deleterious effects on health-related quality of life (HRQOL) as adults age. This study examined differences in HRQOL between cancer and matched noncancer Medicare beneficiaries over 65, within and across two time periods. We used novel matching methods on data from the Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) data resource. We matched SEER-MHOS respondents with cancer from a recent period (2015-2019) to respondents with cancer from an earlier period (2008-2012). We then matched these two cohorts, without replacement, to contemporary cohorts without cancer diagnoses. We estimated Veteran's RAND 12-Item Short Form Survey Physical Component Summary (PCS) and Mental Component Summary (MCS) scores for all cohorts. Our analysis found significantly higher mean MCS scores in the recent period for those with cancer relative to the recent noncancer control group. Breast and lung cancer presented positive and statistically significant trends. We found statistically insignificant differences in PCS scores between the two time periods. No cancer sites had different PCS scores over time compared with the comparison group. Mental health for those with cancer improved more between 2008 and 2019 than a matched noncancer comparison group. Physical health remained stable across time. These findings highlight the importance of including a matched noncancer group when evaluating HRQOL outcomes. SEER-MHOS respondents with cancer report stable PCS scores across 15 years of data and higher MCS scores relative to noncancer controls.

MEDICARE ADVANTAGE (MA) PLAN CHARACTERISTICS ON PHYSICAL AND MENTAL HEALTH OUTCOMES OF MA BENEFICIARIES

Abstract With growing demands for better and cost-effective care delivery by Medicare Advantage (MA) plans, comparison of self-reported health outcomes is more important because those outcomes capture patients’ experiences and perspectives. The purpose of the study is to examine the characteristics of MA plans on Medicare beneficiaries’ physical and mental health status. Methods: I used the Medicare Health Outcomes (HOS) survey, a random sample of Medicare beneficiaries surveyed from each MA plan with a minimum of 500 enrollees conducted by the CMS. The current study included 3 baseline cohorts from 2015 (n=195,800), 2016 (n=178,973), and 2017 (n=172,047). I used physical component summary (PCS) and mental component summary (MCS) scores as two outcomes which include various domains of physical (exercise, pain, activity limitation) and mental health (social functioning, emotional status, depression) status. Plan characteristics include plan ownership status (for-profit (FP) vs. not-for-profit (NFP), plan types (PPO vs. HMO/cost contract), and the number of plan members. I used the linear regression method with clustering at the plan contract level due to the correlation of multiple beneficiaries within the same plan. Results: Adjusted for beneficiary level characteristics, beneficiaries in PPO plans experienced greater physical and mental health scores than HMO or cost contract plans. MA plan with less than 5k beneficiaries is associated with a lower physical health score than plans with more than 100k beneficiaries. For-profit ownership was significantly associated with lower mental health scores. Discussion: The characteristics of MA plan insurers are important factors for beneficiaries’ enrollment decisions and quality improvement efforts.

Performance of the Physical Functioning Activities of Daily Living Scale in the 2020 Medicare Health Outcomes Survey

ObjectiveAssessing functional limitations for adults at high risk of frailty yields valuable information for identifying those in need of therapy. We evaluate a self-report measure used to assess physical function among Medicare recipients in the United States. DesignSecondary analysis of the 2020 Medicare Health Outcomes Survey. SettingA random sample of adult enrollees of 510 managed care plans. Participants287,476 adults (37% completion rate): 58% women; 16% were <65 years old (entitled via disability), 50% 65-74, and 34% 75 or older; 77% White, 14% Black, and 8% another race; 19% had <high school education. InterventionsNot applicable. Main Outcome MeasureWe evaluate item distributions, dimensionality, monotonicity of response options, reliability, and validity of the 8-item Physical Functioning Activities of Daily Living (PFADL) scale. ResultsMost reported they could do 6 basic activities of daily living without difficulty. More limitations were reported for the other 2 PFADL items: 32% were not limited at all in climbing several flights of stairs and 40% in moderate activities. Product-moment correlations among the 8 items ranged from r=0.19 between the easiest-to-do (eating) and most difficult-to-do (climbing several flights of stairs) items to r=0.73 between bathing and dressing. The coefficient alpha and omega for the 8-item scale were both 0.86. Item slopes ranged from 2.6 (climbing several flights of stairs and eating) to 4.8 (dressing). Item characteristic curves revealed that response options were most likely to be selected in the appropriate order along the physical functioning continuum. The PFADL had at least 0.80 reliability between about -3 SDs below the mean to the mean. It was negatively correlated with comorbid condition count, disability days, problems with balance or walking, falling, and obesity. ConclusionsThe PFADL is useful for assessing average or below physical function in Medicare recipients.

Abstract 16014: Health-Related Quality of Life in Patients With Heart Failure is Worse Than in Patients With Cancer: Analysis of the Medicare Health Outcomes Survey 2016-2020

Background: People with heart failure (HF) experience impaired physical and mental health. However, health-related quality of life (HRQOL) in people with HF to those with cancer, another condition that impacts HRQOL, have not been directly compared in a contemporary population. Research Question: How does HRQOL compare in people with HF to those with lung, colon, breast, or prostate cancer? Methods: We performed a pooled analysis of Medicare Health Outcomes Survey data between 2016-2020 in participants ≥65 years with a self-reported history of HF or active treatment for lung, colon, breast, or prostate cancer using two HRQOL measures. The Veterans RAND-12 generates the physical component score (PCS) and mental component score (MCS), which range from 0-100 with a mean score of 50 (based on general US population), a standard deviation of 10, and a lower score representing worse health. We used pairwise t-tests to evaluate for differences in PCS and MCS by group. We used chi-squared to compare the distribution of days with poor physical or mental health in the past 30 days as measured by CDC Healthy Days core questions. Results: Compared to participants with lung, colon, breast, or prostate cancer, participants with HF (n=71,025; 54% female, 16% Black) had lower mean PCS and MCS ( Figure ; P&lt;0.001 for HF vs each cancer). The distribution of unhealthy days differed across disease groups (all P&lt;0.001). Over half (52%) of participants with HF reported ≥10 physically unhealthy days, which is higher than those with lung (51%), colon (41%), breast (31%), or prostate cancer (28%). Nearly one-third (32%) of participants with HF reported ≥10 mentally unhealthy days, which is higher than those with lung (28%), colon (25%), breast (21%), or prostate cancer (20%). Conclusions: People with HF on average experience worse HRQOL than those with cancer. The pervasiveness of low HRQOL in HF underscores the need to implement evidence-based interventions to improve physical and mental health.

Health Status in Heart Failure and Cancer: Analysis of the Medicare Health Outcomes Survey 2016-2020

BackgroundPeople with heart failure (HF) and cancer experience impaired physical and mental health status. However, health-related quality of life (HRQOL) has not been directly compared between these conditions in a contemporary population of older people. ObjectivesThe authors sought to compare HRQOL in people with HF vs those with lung, colorectal, breast, and prostate cancers. MethodsThe authors performed a pooled analysis of Medicare Health Outcomes Survey data from 2016 to 2020 in participants ≥65 years of age with a self-reported history of HF or active treatment for lung, colon, breast, or prostate cancer. They used the Veterans RAND-12 physical component score (PCS) and mental component score (MCS), which range from 0-100 with a mean score of 50 (based on the U.S. general population) and an SD of 10. The authors used pairwise Student’s t-tests to evaluate for differences in PCS and MCS between groups. ResultsAmong participants with HF (n = 71,025; 54% female, 16% Black), mean PCS was 29.5 and mean MCS 47.9. Mean PCS was lower in people with HF compared with lung (31.2; n = 4,165), colorectal (35.6; n = 4,270), breast (37.7; n = 14,542), and prostate (39.6; n = 17,670) cancer (all P < 0.001). Participants with HF had a significantly lower mean MCS than those with lung (31.2), colon (50.0), breast (52.0), and prostate (53.0) cancer (all P < 0.001). ConclusionsPeople with HF experience worse HRQOL than those with cancer actively receiving treatment. The pervasiveness of low HRQOL in HF underscores the need to implement evidence-based interventions that target physical and mental health status and scale multidisciplinary clinics.

Screening and Treating Urinary Incontinence in Primary Care: A Missed Opportunity.

More than 60% of adult women in the United States have urinary incontinence (UI), with the prevalence increasing to over 80% in women over age 65. Despite its high prevalence, most patients do not seek care and few clinicians screen for UI. The Medicare Health Outcomes Survey queries patients about satisfaction with their provider's discussion and management of UI, but formal recommendations about screening, diagnosis, and treatment are lacking. This review presents a practical algorithm for primary care providers to incorporate management of UI into routine preventive care for women, and outlines UI prevalence, risk factors, screening, and non-surgical treatment options.

Racial and Ethnic Disparities in Health-Related Quality of Life for Patients with Colorectal Cancer: Analysis of the SEER-MHOS Linked Data Set

We hypothesized that racial and ethnic disparities exist in health-related quality of life (HRQOL) among older adults with colorectal cancer, both before and after diagnosis. The Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey (SEER-MHOS) linked data set was used to identify patients 65 years old and above who were diagnosed with colorectal cancer between 1996 and 2015. Self-reported race/ethnicity, the predictor of interest, was categorized as White (W), Asian/Pacific Islander (API), Black/African American (B), or Hispanic (H). HRQOL data from the 36-Item Short Form Survey and Veterans RAND 12-Item Health Survey were extracted within 24 months pre- and post-diagnosis. HRQOL was measured using the Physical Component Summary (PCS), Mental Component Summary (MCS), and Total Component Summary (TCS, a summation of PCS and MCS), which were the response variables. Associations were assessed via univariable (UVA) and multivariable (MVA) linear regression analysis, adjusting for age, sex, region, marital status, education, income, number of comorbidities, limitations in activities of daily living, stage, and histology. Pairwise comparisons were performed between all racial and ethnic groups. We identified a total of 1,204 evaluable patients, with 815 in the pre-diagnosis cohort and 562 in the post-diagnosis cohort, including 173 patients in both. With unadjusted p-values, pre-diagnosis UVA revealed a higher mean PCS in API patients compared to W, B, and H patients (p<0.001, p<0.001, p = 0.02) as well as in W compared to H patients (p = 0.002); a higher mean MCS in W and API patients compared to B (p<0.001, p = 0.002) and H patients (p<0.001, p = 0.002); and a higher mean TCS in API compared to W, B, and H patients (p = 0.027, p<0.001, p<0.001) as well as in W compared to B and H patients (p<0.001, p = 0.012). Pre-diagnosis MVA revealed a higher mean PCS in API compared to B patients (p = 0.028) and a higher mean MCS in W and B compared to H patients (p = 0.022, p = 0.021). Post-diagnosis UVA showed a higher mean MCS in W compared to B and H patients (p<0.001 for both) as well as in API compared to H patients (p = 0.002), and a higher mean TCS in W and API patients compared to B (p<0.001, p = 0.045) and H patients (p<0.001, p = 0.007). Post-diagnosis MVA showed a higher mean MCS in API compared to H patients (p = 0.035). Compared to pre-diagnosis, post-diagnosis mean TCS was numerically lower for all groups. Among older adults with colorectal cancer, there appear to be racial and ethnic disparities in HRQOL. Before the cancer diagnosis, API patients had better physical HRQOL than B patients, while W and B patients had better mental HRQOL than H patients. After diagnosis, API patients had better mental HRQOL than H patients. For all groups, the cancer diagnosis seemed to have a negative impact on overall HRQOL.

Health-related Quality of Life in Elderly Asian American and Non-Hispanic White Cancer Survivors.

The purpose of this study was to assess predictors of health-related quality of life (HRQoL) in elderly Asian American and non-Hispanic White cancer survivors. We conducted cross-sectional secondary data analyses using the combined datasets from the Surveillance, Epidemiology, and End Results program and the Medicare Health Outcomes Survey. Elderly Asian American cancer survivors reported a lower mental HRQoL but a comparable physical HRQoL relative to elderly non-Hispanic White cancer survivors. Stress factors, such as comorbidities, difficulties with activities of daily living, and a history of depressive symptoms, along with coping resources like self-rated health and the ability to take the survey in English, were significantly associated with mental and physical HRQoL. Among elderly Asian American cancer survivors, a significantly lower mental HRQoL was observed among those taking the survey in the Chinese language. The findings suggest that race exerts a differential impact on HRQoL. Interventions should be designed to address the distinct cultural, linguistic, and systemic needs of elderly Asian American cancer survivors. Such an approach could assist in reducing cancer-related health disparities.

Abstract PD6-02: PD6-02 Health-Related Quality of Life Trajectories and Predictors among Older Breast Cancer Survivors: A SEER-MHOS analysis

Abstract Health-related quality of life (HRQOL) is an important issue for breast cancer patients and clinicians in the treatment decision process. In addition, older women are more vulnerable due to pre-existing comorbidities and socioeconomic status. This study explored 10-year trajectories of HRQoL in older breast cancer survivors and their predictors using patient-reported outcomes data queried from the Surveillance, Epidemiology and End Results - Medicare Health Outcomes Survey (SEER-MHOS) data resources among Medicare beneficiaries. Older women diagnosed with breast cancer in 1998-2012 and who participated in the surveys before and at least once after diagnosis were included in the analysis. HRQOL was measured using SF-36/VR-12 questionnaire and summarized as Physical Component Summary (PCS) Score and Mental Component Summary (MCS) Score. Latent Class Growth Mixture Modeling was conducted to identify distinct groups of women with a similar trajectory of HRQOL. A total of 1089 women with breast cancer completed surveys an average of 2.6 times (range 2 - 19). The results showed that there were three latent classes of PCS trajectory: high-declining (46% of the sample), mid-declining (37%), and low-improving (17%). Two latent classes of MCS trajectory were identified: high-stable (76%) and low-declining (24%). The univariate analysis showed that age at diagnosis, body mass index, level of education, geographic region, tumor grade, tumor size, and the number of comorbidities were related to PCS and MCS scores. Multivariable multinomial logistic regression analysis identified the number of comorbidities as the most significant predictor for PCS score and level of education as the most significant predictor for MCS score. Future research needs to identify the most common comorbidities that influence HRQOL deterioration in older breast cancer survivors to develop interventions that better the physical HRQOL in patients. Also, interventions that target less educated, underserved patients to improve mental HRQOL. Citation Format: Eunkyung Lee, Sushantti Rupesh, Katia Ferdowsi, Robert Hines, Victoria Loerzel. PD6-02 Health-Related Quality of Life Trajectories and Predictors among Older Breast Cancer Survivors: A SEER-MHOS analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD6-02.

Abstract P257: Self-Perception of Mental and Physical Health Are Significant Predictors of Activities of Daily Living

Background: Stroke is a leading cause of long-term disability and death worldwide. Stroke results in impaired physical, psychological, and social functions. This study examined the extent to which self-perception of physical and mental health, conditions manageable by behavioral intervention (MBI), and medical conditions contribute to activities of daily living (ADL) performance post-stroke among adults aged 65 and above. Methods: Data from the 2017 Medicare Health Outcomes Survey Cohort 19 were analyzed. The outcome variable was defined as, being able to independently perform basic ADL such as bathing, dressing, eating, getting in and out of the chair, walking, and using the toilet. Stepwise binary logistic regression was used to identify risk factors that predict overall ADL performance. Results: A total of 9,531 older adults with stroke were included in the study, 56.97% of whom were females. Overall, 58.6% had some difficulty or were unable to perform ADLs post-stroke. In the final model, self-perception of physical (OR=0.89, 95% CI=0.883, 0.896) and mental (OR=0.961, 95% CI=0.954, 0.968) health and older (74+) age (OR=1.7, 95% CI=1.452,1.895) were associated with difficulty in self-perception of ADL. A 12.2% increase in explained variance after adding medical conditions such as diabetes, hypertension, cancer, etc. to demographic factors; a 13.6% increment in explained variance after adding conditions MBI such as obesity, smoking, pain, etc.; and a 10.5% increment after adding self-perception of mental and physical health was obtained. The final model explained 39.4% of the total variance in the self-perception of ADL. Conclusion: Not only conditions manageable by behavior interventions, and medical conditions predict performance, but self-perceptions of mental and physical health have an impact on ADL. The significant association between self-perception and ADL found in this study signals the need for new avenues for interventions for persons with stroke with respect to their ability to perform self-care activities. These findings can inform future work that identifies and addresses psychosocial and behavioral risk factors that contribute to ADL.

Abstract C113: Mediation of race/ethnicity disparities in physical patient reported outcomes (PROS) by socioeconomic position, comorbidities, and tumor biology among elderly female breast cancer (BC) patients in the SEER-MHOS database

Abstract Objective: Variations in physical PROs between Non-Hispanic Black (NHB) and Hispanic compared to Non-Hispanic White (NHW) elderly women with BC may be attributable to differences in socioeconomic position (SEP), comorbidities, and tumor biology (TB). We examine the extent to which the race/ethnicity disparity in patient reported physical component score (PCS) is transmitted through these domains. Methods: Data is from the Surveillance, Epidemiology, and End Results- Medicare Health Outcomes Survey dataset (SEER-MHOS) which is used to research health outcomes in cancer patients. The analytic sample (n=19,857) included 14,936 NHW, 2,897 NHB, and 2,024 Hispanic women with newly diagnosed BC between 2010-2017. PCS were calculated using the SF-36/V linear transformation of 0-100 versions of the scale that yield a population mean of 50 and standard deviation of 10 based on 1990 population means. We estimated average controlled direct associations (ACDA) using regression models with predictive margins to evaluate crude and age/body mass index (BMI)-adjusted PCS by race/ethnicity and performed a series of ACDA [with comparison of rescaled coefficients (RC)] controlling for the domains of SEP [household income (&amp;lt; 30K, 30K-80K, &amp;gt;80K) and education attainment [&amp;lt;High School (HS), HS, &amp;gt;HS)], comorbidities [smoking status (current smoker/current non-smoker), diabetic (yes/no), and hypertensive (yes/no)], and tumor biology [stage(1-3), grade (well/moderate/poor), and subtype (luminal A/triple negative)]. Results: Overall, NHB and Hispanic women were younger and had a higher BMI than NHW women. In baseline age/BMI adjusted models, NHWs had PCSs 3.4 points significantly higher than both NHWs and Hispanics (95% CI: 2.8, 3.9 and 2.8, 4.1, respectively). Adjusting for SEP reduced the observed disparity: NHB (1.6; 95% CI: 0.90, 2.3) and Hispanics (0.76; 95% CI: 0.04, 1.6) compared to NHW. Inclusion of all three domains highly attenuated the observed PCS disparities between the minority populations and NHWs (0.20; 95%CI: -1.1, 1.5) for NHB and (0.54; 95%CI: -0.90, 1.99) for Hispanics compared to NHWs]. Based on the method of RC, we determined the SEP accounted for the largest fraction of mediated effects, followed by comorbidities, with TB having the smallest effect. Conclusion: Our findings support the hypothesis that observed racial/ethnicity differences in physical PROs in elderly BC patients are largely mediated by differences in SEP and comorbidity, rather than TB. Citation Format: Kristen E. Champion, Kendra Krebsbach, Chloe Stallion, Keith A. Dookeran. Mediation of race/ethnicity disparities in physical patient reported outcomes (PROS) by socioeconomic position, comorbidities, and tumor biology among elderly female breast cancer (BC) patients in the SEER-MHOS database [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C113.

Impact of Prediagnosis Risk of Major Depressive Disorder and Health-Related Quality of Life on Treatment Choice for Stage II-III Rectal Cancer

We hypothesized that depressive symptoms and health-related quality of life (HRQOL) reported by patients before their cancer diagnoses would be associated with treatment choice for stage II and III rectal cancer, specifically whether patients underwent surgery. The Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey linked data set was used to identify patients with stage II-III rectal adenocarcinoma diagnosed between 2004 and 2013 who had completed the health outcomes survey within 36 months before their cancer diagnoses. Risk for major depressive disorder (MDD) was determined on the basis of responses to screening questions for depressive disorders. HRQOL was assessed using the Mental Component Summary and Physical Component Summary of the 36-Item Short Form Survey and Veterans RAND 12-Item Health Survey. Using univariable and multivariable analyses, we assessed for associations between health survey responses and ultimate treatment modality. We identified 142 evaluable patients, of whom 109 (76.8%) underwent surgery. Thirty patients (21.1%) met criteria for being at risk for MDD before their cancer diagnoses. Patients at risk for MDD underwent surgery less often than those not at risk (P = .0499), and this association strengthened after adjusting for patient characteristics (odds ratio, 0.17; 95% CI, 0.04 to 0.82; P = .027). There was a nonsignificant trend between higher Mental Component Summary scores (indicating higher self-reported mental HRQOL) and increased frequency of undergoing surgery (P = .081). There were no significant associations between the Physical Component Summary and treatment modality. In Medicare beneficiaries with stage II-III rectal cancer, those at risk for MDD underwent standard-of-care treatment with surgery less frequently. Further studies are warranted to assess the effect of mental health on clinical decision making in this patient population.

Adjuvant radiation therapy and health-related quality of life among older women with early-stage endometrial cancer: an analysis using the SEER-MHOS linkage.

Radiation therapy (RT) has been associated with decreased health-related quality of life (HRQOL) in clinical trials of early-stage endometrial cancer (EC), but few studies have examined the association in real-world settings. We assessed HRQOL associated with adjuvant RT for older women with early-stage EC within a large U.S. population-based registry resource. The Surveillance Epidemiology and End Results and the Medicare Health Outcomes Survey linkage (1998-2017) was used to identify women with early-stage EC aged ≥ 65years at survey who received surgery and were diagnosed ≥ 1-year prior (n = 1,140). HRQOL was evaluated with the 36-item Short-Form Health Survey (SF-36) until 2006 and the Veterans RAND 12-Item Health Survey (VR-12) post 2006. Ordinary least squares regression was used to estimate mean difference (MD) in T scores and 95% confidence intervals (CIs) comparing treatment groups (surgery alone, adjuvant external beam radiation therapy [EBRT], or adjuvant vaginal brachytherapy [VBT]) after accounting for confounders using propensity score weighting. Overall, RT was not associated with physical health (MD = 0.97; 95% CI = -1.13, 3.07) or mental health (MD = -0.78; 95% CI = -2.60, 1.05) relative to surgery alone. In analyses by RT type, adjuvant VBT was associated with better general health on the SF-36/VR-12 subscale (MD = 3.59; 95% CI = 0.56, 6.62) relative to surgery alone. No statistically significant associations were observed for adjuvant VBT and physical or mental health, or for adjuvant EBRT and any HRQOL domain. Older women with early-stage EC treated with adjuvant RT did not report worse physical and mental HRQOL scores compared to those treated with surgery alone, though relevant symptoms should be evaluated further to fully understand the disease and treatment specific aspects of the HRQOL.

Use of a microsimulation method for assessing dynamics of smoking status and gains in life expectancy after quitting in a longitudinal cohort of US older adults

ObjectivesPrevious studies were unable to estimate the dynamics of smoking status in the US elderly general population, and no study has assessed the benefit of quitting in terms of resultant...

Differential changes in self-reported quality of life in elderly populations after diagnosis of a genitourinary malignancy.

The time of cancer diagnosis is a major event during which quality of life (QOL) can be affected and represents a crucial time to identify patients at high risk of decline. We sought to compare the differential effects of the diagnosis of 3 major urologic malignancies on QOL. The Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey database was queried for patients who completed a QOL questionnaire (SF-36 or VR-12) before and after a diagnosis of bladder, kidney, or prostate cancer. Primary outcome measures were the mental component summary (MCS), and physical component summary (PCS) scores. Mixed effects linear regression was performed with cancer diagnosis as the primary variable of interest, with race and cardiovascular comorbidity status included as potentially confounding independent variables. There were 3,258 patients with urologic cancers. Both MCS and PCS scores dropped after diagnosis in all disease states. Bladder and kidney cancer patients demonstrated the greatest decline in MCS score (-1.762 points, 95% CI-2.571 to -0.952, P < 0.001) and PCS score (-3.769 points, 95% CI-5.042 to -2.496, P < 0.001), respectively, after adjustment for potential confounders. By contrast, prostate cancer patients demonstrated the smallest decline in both domains. Race and cardiovascular comorbidity status were independently associated with QOL, with an association 2 to 3 times greater than that of cancer diagnosis. Diagnosis of a urologic cancer was associated with a decline in patient-reported QOL, particularly in those with bladder or kidney cancer. Changes in physical health were more prominent than in mental health. Race and cardiovascular comorbidity status influenced QOL domains to a greater extent than specific urologic cancer diagnosis.

Abstract 5866: Racial ethnic variations in trajectory of health-related quality of life in older women with breast cancer

Abstract The purpose of the research study was to explore the ethnic/racial variations in health-related quality of life (HRQoL) scores, and the trajectory of comorbidities in older women with breast cancer. This study analyzed data from the Surveillance, Epidemiology, and End-Results (SEER) – Medicare Health Outcomes Survey (MHOS) linked data resource. The study population consists of 982 women (≥ 65 years old at diagnosis) with primary breast cancer who were diagnosed in 1998-2012 and completed the MHOS survey within 24 months before diagnosis and completed at least one more survey after diagnosis. The study population was grouped into three ethnic/racial groups: Whites (n=791), Black/African American (n=104) and Hispanics (n=87). The mean age of the population was 74.8 ± 6.1. HRQoL was measured using SF-36/VR-12 questionnaire and summarized as Physical Component Summary (PCS) Score and a Mental Component Summary (MCS) Score. Results showed an increase in the PCS score at month 6 after diagnosis, and a decrease at month 12 was observed in Whites and Black/African Americans. A continuous decrease in the PCS score till month 12 and an increase at month 24 was observed in Hispanics. All three groups showed similar trends in MCS scores over time - the MCS score dropped at month 6 but was back at baseline by month 12. The Whites had the highest MCS score out of the three, and Hispanics had the lowest. The MCS score for Hispanics decreased by month 36, whereas it increased for Black/African Americans. The MCS score for Whites remained fairly the same. The results also showed an increase in the total number of comorbidities at month six after diagnosis, along with a decrease to the baseline comorbidities by month 12. Hispanics had the highest increase in comorbidities at month 6 and Whites had the lowest and most stable. The number of comorbidities remained fairly the same in Whites and Black/African Americans, whereas the number of comorbidities increased slightly at month 24 for Hispanics and drastically increased at month 36. Overall, changes in the total number of comorbidities had a negative correlation with the changes in MCS scores, therefore it can be concluded that the number of comorbidities have a negative effect on a patient’s mental health. Whites were observed to have less comorbidities and better MCS scores than Black/African Americans or Hispanics. The information gained from this study will help clinicians and patients in the shared treatment decision process and guide individualized survivorship care plans among older women with breast cancer. Citation Format: Sushantti Rupesh, Eunkyung Lee. Racial ethnic variations in trajectory of health-related quality of life in older women with breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5866.

Relationship of neighborhood and individual socioeconomic status on mortality among older adults: Evidence from cross-level interaction analyses.

BackgroundThe influence of community context and individual socioeconomic status on health is widely recognized. However, the dynamics of how the relationship of neighborhood context on health varies by individual socioeconomic status is less well understood.ObjectiveTo examine the relationship between neighborhood context and mortality among older adults and examine how the influence of neighborhood context on mortality differs by individual socioeconomic status, using two measures of income-level and homeownership.Research design and subjectsA retrospective study of 362,609 Medicare Advantage respondents to the 2014–2015 Medicare Health Outcomes Survey aged 65 and older.MeasuresNeighborhood context was defined using the deciles of the Area Deprivation Index. Logistic regression was used to analyze mortality with interaction terms between income/homeownership and neighborhood deciles to examine cross-level relationships, controlling for age, gender, race/ethnicity, number of chronic conditions, obese/underweight, difficulties in activities of daily living, smoking status, and survey year. Predicted mortality rates by group were calculated from the logistic model results.ResultsLow-income individuals (8.9%) and nonhomeowners (9.1%) had higher mortality rates compared to higher-income individuals (5.3%) and homeowners (5.3%), respectively, and the differences were significant across all neighborhoods even after adjustment. With regression adjustment, older adults residing in less disadvantaged neighborhoods showed lower predicted 2-year mortality among high-income (4.86% in the least disadvantaged neighborhood; 6.06% in the most disadvantaged neighborhood; difference p-value<0.001) or homeowning individuals (4.73% in the least disadvantaged neighborhood; 6.25% in the most disadvantaged neighborhood; difference p-value<0.001). However, this study did not observe a significant difference in predicted mortality rates among low-income individuals by neighborhood (8.7% in the least disadvantaged neighborhood; 8.61% in the most disadvantaged neighborhood; difference p-value = 0.825).ConclusionsLow-income or non-homeowning older adults had a higher risk of mortality regardless of neighborhood socioeconomic status. While living in a less disadvantaged neighborhood provided a protective association for higher-income or homeowning older adults, low-income older adults did not experience an observable benefit.

Falls, walking or balance problems, and limitations in activities of daily living (ADLs) among older endometrial cancer survivors.

Functional status deficits are important quality of life concerns for older cancer survivors. We examined the prevalence of falls, walking/balance problems, and limitations in activities of daily living (ADLs) among older women with a history of endometrial cancer. Cancer registry records from the Surveillance, Epidemiology, and End Results (SEER) program linked with Medicare Health Outcomes Survey (MHOS) data were used to identify endometrial cancer survivors aged ≥ 65years who completed a survey ≥ 1year after their cancer diagnosis (N = 3766), as well as an age- and race-matched group of women without a cancer history (N = 3766). We estimated prevalence ratios (PRs) to compare the prevalence of falls, walking or balance problems, and limitations in ADLs (bathing, dressing, eating, getting in/out of chairs, walking, using the toilet) between groups. Difficulty with walking or balance was more common among survivors than the noncancer group (43% vs 36%; PR = 1.19; 95% CI: 1.10-1.27). Fall prevalence was similar between groups (endometrial cancer: 25%; noncancer: 26%; PR = 0.98; 95% CI: 0.89-1.08). Nearly half of endometrial cancer survivors (47%) reported at least one ADL limitation, with several activities (getting in/out of a chair, walking, bathing, using the toilet) more often limited among survivors than among women without cancer. Functional impairments, especially problems with walking and/or balance, are common among older endometrial cancer survivors. Our results highlight the importance of addressing functional problems during the ongoing survivorship care of women with a history of endometrial cancer, with referral to rehabilitation or other relevant services when indicated.

Physical functioning, frailty and risks of locally-advanced breast cancer among older women

ObjectiveWomen with multiple comorbidities have competing health needs that may delay screening for early detection of breast cancer. Our objective was to determine associations between physical functioning and frailty with risk of locally-advanced breast cancer (BC). MethodsWe conducted a retrospective cohort study of women 65 years and older diagnosed with first primary stage I-III BC using the Surveillance, Epidemiology and End Results Medicare Health Outcome Survey Data Resource. Physical health-related quality of life was measured using Veterans RAND 12 Item Health Survey scales within two years before diagnosis; frailty was determined by calculating deficit-accumulation frailty index (DAFI) scores. Multivariable modified Poisson regression models were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for risk of locally-advanced (stage III) versus early-stage (I-II) BC. ResultsAmong 2411 women with a median age of 75 years at BC diagnosis, 2189 (91%) were diagnosed with incident stage I-II BC and 222 (9%) were diagnosed at stage III. Compared to women with early-stage disease, women with locally-advanced BC had lower physical component scores (37.8 vs. 41.4) and more classified as pre-frail or frail (55% vs. 50%). In multivariable models, frailty was not associated with increased risk of locally-advanced disease. However, worse physical function subscale scores (lowest vs. upper quartile; RR = 1.56, 95% CI 1.04–2.34) were associated with risk of locally-advanced BC. ConclusionsBreast cancer screening among non-frail older women should be personalized to include women with limited physical functioning if the benefits of screening and early detection outweigh the potential harms.