title: Patient function, long-term survival, and use of surgery in patients with kidney cancer.
abstract: BACKGROUND
  Beyond age and comorbidity, functionality can shape the long-term survival potential of patients with cancer. Accordingly, herein the authors compared mortality and receipt of cancer-directed surgery according to patient function among older adults with kidney cancer.
  
  
  METHODS
  Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2000 through 2009, the authors studied 28,326 elderly subjects with primary kidney cancer. Patient function was quantified using function-related indicators, claims indicative of dysfunction and disability. Adjusting for patient and cancer characteristics, competing risk regression was used to assess the relationship between function-related indicator count and cause-specific mortality and then generalized estimating equations were used to quantify the probability of surgery.
  
  
  RESULTS
  A total of 13,619 adult patients (48.1%) with at least 1 function-related indicator were identified. A higher indicator category was associated with older age, greater comorbidity, female sex, unmarried status, lower socioeconomic status, and higher stage of disease (P<.001). Compared with patients with an indicator count of 0, those with an indicator count of 1 (hazard ratio, 1.10; 95% confidence interval [95% CI], 1.04-1.16) and ≥2 (hazard ratio, 1.46; 95% CI, 1.39-1.53) were found to have higher other-cause mortality. Conversely, kidney cancer mortality varied minimally with patient function. Patients with ≥ 2 indicators received cancer-directed surgery less often than those without disability (odds ratio, 0.61; 95% CI, 0.56-0.66), although treatment probabilities remained high for patients with locoregional disease and low for those with metastatic cancer.
  
  
  CONCLUSIONS
  Among older adults with kidney cancer, functional health stands as a significant predictor of long-term survival. However, receipt of cancer-directed surgery appears largely determined by cancer stage. Patient function should be considered more heavily when determining treatment for older adults with kidney cancer. Cancer 2016;122:3776-3784. © 2016 American Cancer Society.
authors: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Hung-Jui
authors: HJ
authors: Tan
authors: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors: Karim
authors: K
authors: Chamie
authors: Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Timothy J
authors: TJ
authors: Daskivich
authors: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.|Department of Health Policy and Management, University of California at Los Angeles Fielding School of Public Health, Los Angeles, California.|University of California at Los Angeles School of Nursing, Los Angeles, California.
authors: Mark S
authors: MS
authors: Litwin
authors: Department of Urology, Weill Cornell School of Medicine, New York, New York.
authors: Jim C
authors: JC
authors: Hu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012307:Risk Factors; D018426:SEER Program; D012923:Social Class
keywords: aged; functional status; kidney neoplasm; nephrectomy; survival