Dissertation/Thesis Abstract

Burden of Living with Kidney Cancer in Older Americans
by Bhandari, Naleen Raj, Ph.D., University of Arkansas for Medical Sciences, 2019, 162; 27543257
Abstract (Summary)

Objectives: (1a) Compare change in health-related quality of life (HRQoL) from pre- to post-diagnosis of kidney cancer (KC) in older KC patients and matched noncancer subjects (controls). (1b) Identify factors associated with HRQoL changes in older KC patients. (2) Evaluate the association between HRQoL and overall survival in older KC patients. (3) Determine one-year and five-year total healthcare costs and resource use associated with renal cell carcinoma (RCC) in the US.

Methods: Three longitudinal, retrospective cohort studies were conducted. The 1998–2013 Surveillance, Epidemiology, and End Results (SEER) linked with Medicare Health Outcomes Survey was used for objectives 1a, 1b, and 2 and 2006–2014 SEER-Medicare claims was for the last objective. Statistical analyses included generalized linear mixed-effects models (objective 1a), ordinary least square regression models (objective 1b), Cox proportional hazard models (objective 2), and linear models using inverse probability weighting accounting for patient censoring (objective 3).

Results: The impact of KC was prominent on older patients’ physical health, social functioning, and vitality. Older patients with advance-stage KC, belonging to lower socio-economic group, or those with a history of stroke or chronic arthritis/sciatica were at a greater risk of deteriorations in HRQoL. Clinically meaningful reductions in patients’ HRQoL from pre- to post-diagnosis of KC was significantly associated with their long-term overall survival. Lastly, we observed that the healthcare sector spent, on average, 3–7 times and 1–5 times more healthcare dollars for patients with RCC compared to controls, for one-year and five-year after RCC diagnosis, respectively.

Conclusions: Burden of living with KC is substantial on older Americans with KC as well as the US healthcare system. The findings may help clinicians set patient’s expectations about their physical health changes after KC diagnosis and its treatment and become more aware of the risk factors associated with HRQoL deterioration. Given the rising interest in utilizing patient-reported outcomes in clinical oncology settings, HRQoL monitoring should be added to the long-term care plan for KC patients. Estimated economic costs of RCC from this study can be useful to healthcare policymakers and payers in planning resource allocations and determining future research priorities in this patient population.

Indexing (document details)
Advisor: Payakachat, Nalin
Commitee: Kent, Erin E., McAdam-Marx, Carrie, Kamel, Mohamed, Ounpraseuth, Songthip T., Tilford, J. Mick
School: University of Arkansas for Medical Sciences
Department: Pharmaceutical Sciences
School Location: United States -- Arkansas
Source: DAI-B 81/5(E), Dissertation Abstracts International
Subjects: Pharmaceutical sciences, Health sciences
Keywords: Clinical outcomes, Economic outcomes, Health outcomes, Kidney cancer, Older Americans, Renal cell carcinoma
Publication Number: 27543257
ISBN: 9781392555873
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