Anemia and Functional Disability in Older Adults With Cancer

Authors:
Cynthia Owusu From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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Harvey Jay Cohen From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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Tao Feng From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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William Tew From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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Supriya G. Mohile From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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Heidi D. Klepin From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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Cary P. Gross From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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Ajeet Gajra From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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Stuart M. Lichtman From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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Arti Hurria From Case Western Reserve University, Cleveland, Ohio; Duke University School of Medicine, Durham, North Carolina; City of Hope Comprehensive Cancer Center, Duarte, California; Memorial Sloan Kettering Cancer Center, New York, New York; University of Rochester, Rochester, New York; Wake Forest School of Medicine, Winston-Salem, North Carolina; Cancer Outcomes Public Policy and Effectiveness (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut; and Upstate Medical University and VA Medical Center, Syracuse, New York.

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on behalf of the Cancer and Aging Research Group (CARG)
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Volume/Issue:
Volume 13: Issue 10
Online Publication Date:
Oct 2015
DOI:
https://doi.org/10.6004/jnccn.2015.0152
Restricted access

Objectives: Anemia is associated with functional disability among older adults in general. However, the relationship between anemia and functional disability has not been well characterized among older adults with cancer. Therefore, we examined the association between anemia and functional disability in patients with cancer aged 65 years or older. Patients and Methods: We conducted cross-sectional analysis of data derived from a multicenter prospective study of 500 patients with cancer aged 65 years or older. The primary outcome was functional disability at chemotherapy initiation, defined as the need for assistance with at least one instrumental activity of daily living. Anemia (using WHO criteria) was defined as a hemoglobin (Hb) level of less than 12 g/dL in women and less than 13 g/dL in men. Multivariable logistic regression was used to examine the association between anemia and functional disability. Results: Among 491 evaluable patients (median age, 73.1 years [range, 65–91 years]), the prevalence of functional disability and anemia was 43% and 51%, respectively. Compared with patients without anemia, patients with anemia were more likely to report functional disability. On multivariable analysis, adjusting for sex, stage, and unintentional weight loss, patients with anemia were more likely to have functional disability (odds ratio, 2.40; 95% CI, 1.61–3.59). Conclusions: Anemia was highly prevalent and independently associated with functional disability in this cohort of older adults with cancer. Given the importance of functional status in cancer treatment decision-making, longitudinal studies evaluating the causal relation between anemia and functional status among older patients with cancer are warranted to evaluate causality.

Correspondence: Cynthia Owusu, MD, MS, Case Western Reserve University, UHHS Seidman Cancer Center-BHC 5055, 11100 Euclid Avenue, Cleveland, OH 44106-5055. E-mail: cynthia.owusu@case.edu
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
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Copyright:
Copyright © 2015 by the National Comprehensive Cancer Network 2015
Page Numbers:
7
Article Category:
Research Article
Received:
05 Apr 2015
Accepted:
23 Jul 2015
Print Publication Date:
01 Oct 2015
Online Publication Date:
Oct 2015

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