Impact of Physical Comorbidities on Treatment Commencement and Quality of Life Among Geriatric Oncology Patients – A Rural Australian Study

Abstract

<p>This research aimed to determine the impact of physical comorbidity on the treatment commencement and quality of life of cancer therapy in a specific rural cohort of oncology patients aged 65 years and older (“geriatric oncology patients”). The study employed both quantitative and qualitative research methods to determine the impact of comorbidities in treating geriatric oncology patients. Quantitative data was obtained using standardized questionnaires and various assessment tools to gather information regarding patients’ sociodemographic details, cancer-related information, treatment access, commencement and quality of life. The qualitative component of the study adopted an approach comprising Focus Group Discussions to gather in-depth information and perspectives of patients, caregivers, and health professionals on the barriers and challenges faced in accessing treatment by geriatric cancer patients in a rural setting. Data were analyzed descriptively to understand the participant characteristics, rurality of residence, and cancer-related details at the baseline using frequencies and cross-tabulations. Participants of this study identified travel to larger regional centers and/or metropolitan areas and related arrangements as primary challenges to accessing diagnostic tests, surgeries, some treatments, and follow-up tests. For the prevalence of physical comorbidities, the majority of the study population reported 2-6 comorbidities and COPD was the most prevalent comorbidity. An overall reduction in QoL was observed when comparing QoL scores at baseline and after the completion of the fourth treatment cycle. The patients with higher comorbidity burden experienced a greater negative impact on their QoL following 4 cycles of cancer treatment. Examination of the relationship between comorbidity and cancer outcome revealed disease progression in patients with higher comorbidity burden than those with lower comorbidity burden. For the association between comorbidity and different treatment choice the results showed that having comorbidity and higher comorbidity burden was associated with increased possibility of receiving palliative treatment, and decreased possibility of receiving curative treatment. Presence of comorbidities plays a role in treatment decisions and thus may have a negative prognostic impact, which is evident from the results of the study. The study concluded that higher comorbidity burden could be considered a strong predictor of poor cancer outcomes and reduced HRQOL in a rurally-located geriatric population. This study emphasises that understanding the impact of comorbidities on the geriatric oncology patient's clinical journey will provide insight into cancer management and addressing the QoL needs of these patients in a rural Australian setting.</p>