Abstract 5748: Declines in health-related quality of life among older patients diagnosed with hematologic malignancies
Authors: Zolekar Ashwini , Nabulsi Nadia A. , Asfaw Alemseged A. , Zhou Jifang , Sweiss Karen , Patel Pritesh R. , Chiu Brian C.-H. , Nutescu Edith A. , Calip Gregory S. 
Published: September 2020

Background: The diagnosis of cancer and its treatment have meaningful impacts on health-related quality of life (HRQOL). Although advances in novel therapy and stem cell transplantation have increased survival in patients with hematologic malignancies (HM), less evidence exists on the subsequent impacts of HM on HRQOL. The objective of this study was to evaluate changes in HRQOL following diagnosis of HM in a cohort of older Medicare beneficiaries.

Methods: This was a retrospective study utilizing the Surveillance, Epidemiology and End Results Medicare Health Outcomes Survey Data Resource, a linkage of longitudinal surveys and cancer registry data. We included patients ages ≥65 years diagnosed with first primary leukemia, lymphoma or multiple myeloma between 1998 and 2014 who completed at least one survey within two years pre- and post-diagnosis. HRQOL was measured using the Short Form Health Survey (SF-36) composite scores with a minimum clinically important difference of 2 points. We also measured self-reported general health, depressive symptoms, and the deficit-accumulation frailty index before and after HM diagnosis. Patients with HM were compared to up to four patients without cancer with exact matching on age, sex, race, marital status, smoking status, education, comorbid conditions, proxy response and calendar time of HM diagnosis. Comparisons of means were performed between groups using ANOVA with adjustment for survey type.

Results: Among 401 patients with HM included in our analysis, mean (SD) age of diagnosis was 75.98 (6.2) years and 26% were diagnosed with leukemia, 57% with lymphoma, and 17% with multiple myeloma. No significant differences in HRQOL, self-reported health, depressive symptoms, or frailty were observed between patients with HM and their non-cancer matches (n=1578) before diagnosis. Substantial declines in HRQOL were observed across all types of HM after cancer diagnosis. Mean decreases in composite SF-36 scores among patients with HM (physical component score [PCS] -7.1, 95% CI -8.8, -5.5; mental component score [MCS] -3.4, 95% CI -4.9, -1.8) were greater in magnitude compared to declines in matched non-cancer patients (PCS -1.6, 95% CI -2.4, -0.7; MCS -0.6, 95% CI -1.3, 0.1). During follow-up, patients with HM also had higher rates of low self-reported health (46% vs. 27%), depressive symptoms (34% vs. 25%) and frailty (56% vs. 43%).

Conclusion: Our study found decreases in HRQOL measures among older patients with HM that were more than three-fold higher than the minimum clinically important differences in the general population and twice that reported in older patients with common solid tumors. Prospective studies and clinical trials in patients with leukemia, lymphoma, and multiple myeloma should include measures that assess whether life-prolonging, novel therapies are also effective in preserving HRQOL.

Citation Format: Ashwini Zolekar, Nadia A. Nabulsi, Alemseged A. Asfaw, Jifang Zhou, Karen Sweiss, Pritesh R. Patel, Brian C.-H. Chiu, Edith A. Nutescu, Gregory S. Calip. Declines in health-related quality of life among older patients diagnosed with hematologic malignancies [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5748.