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Physical and Mental Health Status of Older Long-Term Cancer Survivors

Authors

  • Nancy L. Keating MD, MPH,

    1. From the *Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MassachusettsDepartment of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Health Services Research, Institute of Public Health, University of Copenhagen, Denmark§National Bureau of Economic Research, Cambridge, Massachusetts
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  • Marie Nørredam MD,

    1. From the *Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MassachusettsDepartment of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Health Services Research, Institute of Public Health, University of Copenhagen, Denmark§National Bureau of Economic Research, Cambridge, Massachusetts
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  • Mary Beth Landrum PhD,

    1. From the *Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MassachusettsDepartment of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Health Services Research, Institute of Public Health, University of Copenhagen, Denmark§National Bureau of Economic Research, Cambridge, Massachusetts
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  • Haiden A. Huskamp PhD,

    1. From the *Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MassachusettsDepartment of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Health Services Research, Institute of Public Health, University of Copenhagen, Denmark§National Bureau of Economic Research, Cambridge, Massachusetts
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  • Ellen Meara PhD

    1. From the *Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MassachusettsDepartment of Health Care Policy, Harvard Medical School, Boston, MassachusettsDepartment of Health Services Research, Institute of Public Health, University of Copenhagen, Denmark§National Bureau of Economic Research, Cambridge, Massachusetts
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  • This work was funded by a Clinical Scientist Development Award from the Doris Duke Charitable Foundation. Dr. Keating's effort was also supported in part by the National Cancer Institute (Grant U01 CA93324) through the Cancer Care Outcomes Research and Surveillance Consortium. Dr. Huskamp's effort was supported by NIMH K01 MH66109.

Address correspondence to Nancy L. Keating, MD, MPH, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115. E-mail: keating@hcp.med.harvard.edu

Abstract

Objectives: To assess the physical and mental health status of older long-term cancer survivors.

Design: Cohort study using propensity score methods to control for baseline differences between cancer survivors and controls.

Setting: General community population in the United States.

Participants: Nine hundred sixty-four cancer patients who had survived for more than 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans aged 55 and older responding to the 2002 Health and Retirement Study.

Measurements: Medical conditions, symptoms, health behaviors, health status, mobility, activities of daily living, mental health diagnoses, self-rated memory, depressive symptoms, cognitive function, and self-reported life expectancy.

Results: Cancer survivors reported higher rates of lung disease (13.9% vs 9.6%; P=.001), heart condition (29.3% vs 22.9%; P<.001), arthritis (69.4% vs 59.4%; P<.001), incontinence (26.6% vs 19.7%; P=.001), frequent pain (36.4% vs 29.4%; P=.005), and obesity (27.0% vs 24.2%; P=.001) than individuals without cancer but lower rates of smoking (12.0% vs 14.8%; P=.03). Cancer survivors were less likely than persons without cancer to report excellent or very good health status (37.2% vs 44.6%; P<.001) and had more mobility (P<.001) and activity of daily living (P=.01) limitations. Cancer survivors did not differ from persons without cancer in rates of depression or cognitive function (both P>.2) but were less optimistic about their life expectancy (P=.004).

Conclusion: The physical health status of older long-term cancer survivors is somewhat worse than that of comparable persons who have never had cancer, but they have surprisingly similar mental health status. Future research is needed to understand factors contributing to poorer health status and identify patients at highest risk of long-term cancer-related problems.

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