Table 1 Results and characteristics of the included studies

1

Krahn et al., 2013, Canada [23]

To measure quality of life (QoL) and utilities for prostate cancer (PC) patients and determine their predictors

Prospective cohort study

A population-based, community-dwelling, geographically diverse sample of long-term prostate cancer survivors in Ontario, Canada was identified from the Ontario Cancer Registry and contacted through their referring physician

585 prostate cancer patients, mean age 72.6 years (range 43–98) 2–13 years post diagnosis. 80 male patients (13,7%) > 80 years

PORPUS

HUI2/3

FACT-P

PCI

Mean utility scores were as follows: PORPUS-U = 0.92, HUI2 = 0.85, and HUI3 = 0.78. Mean health profile scores were as follows: PORPUS-P = 71.7, PCI sexual, urinary, and bowel function = 23.7, 79.1, and 84.6, respectively (0 = worst, 100 = best), and FACT-P = 125.1 (0 = worst, 156 = best). In multiple regression analyses, comorbidity, and PCI urinary, sexual, and bowel function were significant predictors of other QOL measures. With all variables, 32–50% of the variance in utilities was explained

There were monotonic declines in quality of life for each decade of age (Fig. 2). For example, mean PORPUS-U scores were 0.95 in patients aged under 60 years old and 0.89 in those aged over 80 years old. Prostate Cancer (PC)-specific quality of life also declined with age. Only urinary function scores were not affected by age (Fig. 3). Global and PC-specific health status also declined across comorbidity strata (Figs.2,3)

Comorbidity was the most consistent patient-related predictor of quality of life (Table3)

Many variables affect global QoL of PC survivors; only prostate symptoms and comorbidity have independent effects. Our model allows estimation of the effects of multiple factors on utilities. These utilities for long-term outcomes of PC and its treatment are valuable for decision/cost-effectiveness models of PC treatment. Prostate cancer (PC) exerts enormous health and economic burdens which will only rise in coming decades given ageing demographics and trends in Prostate Cancer diagnosis, treatment, and survivorship. This study provides unique information about the effects of PC symptoms in long-term survivors

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2

Esbezen et al., 2004, Denmark [24]

To investigate quality of life (QoL) in elderly persons newly diagnosed with cancer (65 + years) in relation to age, contact with the health-care system, ability to perform activities of daily living (ADL), hope, social network, and support, and to identify which factors were associated with low QoL

Prospective cohort study

The sample consisted of 101 patients (75 women and 26 men) newly diagnosed with cancer. Median age was 74.74 years (IQR 8.75). 23 patients (23%) > 80 years

EORTC QLQ-C30

The analysis was carried out across four age groups and revealed no significant differences among the four age groups in the three sub-scales in EORTC QLQ-C30 (Table 1). Factors significantly associated with low QoL in global health status/QoL were ‘No other incomes than retirement pension’, ‘Low level of hope’ and ‘Lung cancer’ (Table 4). Compared with the other age groups, those of a high age (80 + years) more often lived alone, used more at-home care service, and had a smaller social network. In addition, ‘being told that the cancer disease has not come to an end’, ‘needing more help in activities of daily living’, ‘getting help from grown-up children’ and ‘needing help with PADL’ were associated with low QoL

Those at risk of inferior QoL, that is, being in a poor financial situation, having a low level of hope and lung cancer need special attention and specific interventions to improve QoL

There were no significant differences among age groups regarding dependency in IADL and PADL (Table 2)

The oldest age group (80 + years) had significantly (P = 0.001) fewer stays in hospital within the preceding 6 months (73.9%) and received more at-home care than the other three age groups (Table 3). There were no differences among age groups in ‘need [of] more help’ and 75.8% of the total group needed more help in daily living

The results from this study indicate that the oldest age group (80 + years) had a poorer social network and needed more support from at-home care services than the younger participants. Dependency, getting help from grown-up children and receiving help in daily living were also related to low QoL for the total sample

The results also showed that the type of cancer diagnosis and perceived seriousness of it were of importance to QoL. Additionally, limited financial resources and low level of hope for an elderly person newly diagnosed with cancer were associated with a higher risk for low QoL

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3

Thome, B. and Hallberg, I. R. (2004), Sweden [25]

To investigate quality of life (QoL) and its association with sense of coherence (SOC), complaints, comorbidity, social resources, perceived financial situation and receiving help for daily living, investigating differences between women and men aged 75 and above with cancer, and comparing women and men aged 75 and above without cancer. A further aim was to identify which of these factors was associated with low QoL in older people with cancer

Cross-sectional

Women (n = 74, mean age 84.3 (SD 5.9)) and men (n = 76, mean age 84.3 (SD 5.6)), with a cancer disease (n = 150). 93 patients (62%) > 80 years And a matched group (age and receiving help for daily living) of women (n = 64, mean age 83.1) and men (n = 74, mean age 83.5) without cancer (n = 138)

EORTC

QLQ- C30

and

SF-12

The only significant difference in EORTC QLQ-C30 between age groups within the study group was found in physical functioning between the youngest and the oldest age group. There were significant differences within the comparison group between age groups in the EORTC QLQ-C30 domains physical, role, cognitive and social functioning, and in symptom scales/items fatigue and appetite loss with the lowest/highest scores in the oldest age group. The study group had significantly lower scores (poorer QoL) in SF-12 (PCS, MCS) than the comparison group. However, significant differences were only found between the youngest age groups (75–79). No differences were found in SF-12 (PCS, MCS) between age groups within the study group. The comparison group, however, showed significant differences between all age groups in SF-12 PCS, with the lowest scores in the oldest age group. Women with cancer were more vulnerable than their male counterparts in QoL, SOC, perceived economic situation and social resources. Factors associated with low QoL in older people with cancer were receiving help for daily living, comorbidity, degree of complaints and pain

Younger old people seem to be more affected when stricken by cancer, whilst cancer in older age appears to be more integrated in age-associated conditions such as declining functional ability, increasing complaints and comorbidity. Receiving help for daily life contributes strongly to low QoL. Furthermore, cancer seems to affect QoL in women more than in men, and economic problems seem to be additionally related to the poorer QoL in women. Providing high-quality care to the younger segment of elderly people with cancer may require a focus on the disease, while care for the eldest may require a more comprehensive assessment of age-associated conditions as well as cancer

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