Disparities in survival predictors of older cancer patients in Bangladesh: A multicenter study.
Authors: Muhammad Rafiqul Islam, Syeda Masuma Siddiqua, Salman Bashar Al Ayub, Rashedul Islam, Beauty Saha, Mohammad habibur Rahman, Nazrina Khatun, Mohammad Hasan Shahriar, Muhammad Ashique Haider Chowdhury, Siara Tasmin, Andrew Craver, Izabela Ono Adriazola, Habibul Ahsan
Journal: Journal of Clinical Oncology (2025)

e13845 Background: The global aging population has led to increased cancer prevalence among older adults, particularly in low- and middle-income countries (LMICs). In Bangladesh, this demographic shift significantly challenges the healthcare system, as elderly cancer patients often present with complex medical needs including multiple comorbidities and varying levels of functional independence. Despite the growing magnitude of this public health challenge, research in geriatric oncology within Bangladesh remains limited. Critical gaps exist in understanding age-specific cancer patterns, treatment outcomes, and healthcare delivery models. Methods: A 27-month cohort study (Oct 2021 - Jan 2024) across three hospitals in Bangladesh enrolled 862 cancer patients aged 60+, with 581 completing the study. Data on demographics, medical history, physical status, and treatments were collected through questionnaires and follow-up. Survival analysis was conducted using the Kaplan-Meier method, and Cox regression models identified key survival predictor. Results: In this study of 581 cancer patients (mean age 65.9 years), 67.47% (n = 392) died during the follow-up period. The cohort was predominantly composed of lung cancer patients (43.5%), though breast cancer patients showed the highest survival rate at 56.61%. The average survival duration was 505.6 days, with significant variation by cancer type - ranging from 241.2 days for Cancer of Unknown Primary (CUP) to 758.4 days for sarcoma patients. The analysis revealed several significant prognostic factors. Mortality risk increased slightly with age (HR 1.02, 95% CI:1.01, 1.04, p = 0.04) and substantially with advanced cancer stage (HR 1.67, 95% CI:1.10, 2.54, p = 0.01). Protective factors associated with improved survival included adequate food intake (HR 0.47, 95% CI:0.31, 0.72, p = 0.00), better mobility (HR 0.62, 95% CI:0.40, 0.94, p = 0.02), and positive health perception (HR 0.54, 95% CI:0.38, 0.75, p = 0.00). G8 scores reflected this pattern, with surviving patients averaging 10.4 compared to 8.6 in the deceased group. Treatment-related factors significantly impacted survival. Intensive platinum-based chemotherapy with more than two drugs increased mortality risk (HR 2.03, 95% CI:1.14, 3.63, p = 0.01) compared to non-platinum or oral drug regimens. Conversely, post-diagnosis surgery was associated with improved survival outcomes. The multivariate analysis found no significant impact of sex, comorbidities, or polypharmacy on survival outcomes. Conclusions: This study highlights unique prognostic patterns in elderly cancer patients within resource-limited settings, warranting the implementation of cost-effective screening tools and locally adapted risk assessments. Future research should prioritize developing sustainable protocols tailored to these resource-constrained environments.