Dissertation Defense Announcement

School of Public Health announces the Final Dissertation Defense of

Prachi Chavan

for the Degree of Doctor of Philosophy

June 18, 2019 at 11:00 AM in Robison Hall,Room 117

Advisor: Dr. Xinhua Yu

Implications of Functional Limitations in Older Cancer Survivors A Medicare Beneficiary Survey

ABSTRACT: The purpose of this dissertation was to evaluate the impact of physical and functional limitations among older cancer survivors and its effect on healthcare utilization and mortality among them. The Medicare Current Beneficiary Survey (MCBS) is nationally representative longitudinal study of older Medicare beneficiaries. Physical Limitations (PL), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) were measured on a five-point scale. MCBS data from 2005 to 2013 were used in this study. Propensity score weighting was developed using logistic regressions. Design-based descriptive analysis and logistic models with adjusted survey weights were performed. Logistic and Poisson regression models were developed for hospitalization, re-hospitalization and mortality rates. Cancer survivors had higher functional limitations compared to non-cancer individuals. After adjusting for socio-demographic characteristics and cancer survivors were more likely to have physical limitations (OR: 1.62, 95% CI: 1.28-2.06). There was a one-year lag in functional limitations resulting in one-year loss of physical capabilities among cancer survivors compared to non-cancer beneficiaries. Older cancer survivors with physical and functional limitations had higher rate of emergency department visits than those without limitations (PL: 21.8%vs.17%, aOR:1.72, 95% CI: 1.26–2.35, p<0.05; ADL: 25.8%vs.17.4%, aOR: 2.68, 95% CI: 1.86–3.86, p<0.001) and higher cost of hospitalization (IADL: mean=$24,916, SD:3,877.1). Cancer survivors with poor self-assessed health had higher rate of hospitalizations (aOR:1.60, 95% C.I.: 1.47 – 1.72, p<0.0001) compared to non-cancer participants. Compared to participants with no history of cancer, cancer survivors with IADL (RR: 1.41, 95% C.I.: 1.25 – 1.58, p<0.0001) and poor self-assessed health (RR: 1.39, 95% C.I.:1.21-1.60, p<0.05) were more likely to have higher number of hospital re-admissions within 30 days of a prior hospitalization. Our findings extend our understanding of the burden of physical and functional limitations in cancer survivors. Older cancer survivors with physical and functional limitations had higher healthcare utilization compared to those without cancer. Addressing complex and unique healthcare needs in this population will help reduce excess burden on the healthcare system. Health care providers should incorporate formal assessments of functional status among older patients in their clinical practice.