Geriatric impairments were directly and indirectly associated with mortality in older patients with cancer: a structural equation analysis

Florence Canoui-Poitrine (1, 2) , Claudia Martinez-Tapia (1) , Elena Paillaud (1, 2, 3, 4) , Simone Mathoulin-Pelissier (5, 6) , Frederic Pamoukdjian (7, 8) , Matthieu Frasca (5, 9) , Anna-Maija Tolppanen (10) , Michael Bringuier (11, 12) , Etienne Brain (13) , Amaury Broussier (1, 2) , Sylvie Bastuji-Garin (1, 2) , Marie Laurent (1, 2) , Etienne Audureau (1, 2)

1 U955 Inserm - UPEC - IMRB - CEPIA/"Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health" [Créteil]
2 Hôpital Henri Mondor
3 Cancer Research and Personalized Medicine - CARPEM [Paris]
4 HEGP - Hôpital Européen Georges Pompidou [APHP]
5 BPH - Bordeaux population health
6 CIC Bordeaux
7 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
8 Hôpital Avicenne [AP-HP]
9 CHU Bordeaux
10 University of Eastern Finland
11 Institut Curie [Saint-Cloud]
12 PSL - Université Paris Sciences et Lettres
13 Hôpital René Huguenin [Saint-Cloud]

OBJECTIVE: We assessed the direct and indirect effects between six geriatric domains and 6- and 12-month mortality in older cancer patients. STUDY DESIGN AND SETTING: We included cancer patients aged ≥70 from the ELCAPA cohort, referred for geriatric assessment between 2007 and 2016. We used structural equation modelling to examine the interrelationships between six geriatric domains (function and mobility, nutrition, cognition, mood, comorbidities and polypharmacy, and social support) and the direct and indirect relationships between these domains, the cancer stage, site, and treatment on one hand and mortality on the other. RESULTS: The analysis included 1434 patients (mean age: 80 ± 5.6; women: 48%; main cancer sites: digestive tract (36.2%), urinary tract and prostate (26.6%), and breast (16.5%); metastatic cancer: 48%). Direct relationships to 6- and 12- month mortality were identified for functional impairment (standardized coefficient (SC): 0.37 (P<0.001) and 0.32 (P<0.001), respectively), poor nutritional status (SC: 0.11 (P=0.005) and 0.14 (P=0.001)), poor social support (SC=0.07 (P=0.08) and 0.09 (P=0.02)), cancer site, stage, and treatment. The effects of comorbidities, cognitive impairment and depression on mortality were mediated by functional and nutritional status. CONCLUSION: In older cancer patients, functional and nutritional impairments were the strongest direct prognostic geriatric factors for mortality.

Mots clés: Geriatric assessment; Cancer; Survival; Structural equation modelling; Direct and indirect effects; Interrelationships

Domaines: Santé publique et épidémiologie

Florence Canoui-Poitrine, Claudia Martinez-Tapia, Elena Paillaud, Simone Mathoulin-Pelissier, Frederic Pamoukdjian, et al.. Geriatric impairments were directly and indirectly associated with mortality in older patients with cancer: a structural equation analysis. Journal of Clinical Epidemiology, 2022, 148, pp.17-26. ⟨10.1016/j.jclinepi.2022.04.004⟩. ⟨hal-03668837⟩