# Cognitive Impairment, Multimorbidity, and end-of-life care in older cancer patients

> **NIH NIH P30** · CASE WESTERN RESERVE UNIVERSITY · 2020 · $404,835

## Abstract

PROJECT SUMMARY:
 Over 1.5 million individuals reside in U.S. nursing homes (NH); of those, nearly 150,000 have been or will
be diagnosed with cancer. The treatment of cancer among NH residents is complicated by the fact that
institutionalized older adults are also likely to suffer from cognitive impairment (COG-I) and complex
multimorbidity (MM; defined as co-occurrence of chronic conditions, functional limitations, and/or geriatric
syndromes). Thus, NH cancer patients are particularly susceptible to severe depletion of functional and
physiologic reserves, and increased morbidity and mortality. In addition, racial/ethnic disparities across these
factors add further complexity to cancer care decisions among NH residents.
 Despite these vulnerabilities, very little is known about NH cancer patients’ patterns of cancer care,
including incomplete diagnostic evaluation resulting in unstaged cancers, use of cancer-directed treatment,
end-of-life (EOL) care, and associated costs. Indeed, there remains a critical need to characterize this patient
population and variations in cancer care, especially by gradients of COG-I and MM complexity, and when
cultural factors may favor aggressive EOL care. Key questions have yet to be addressed, including: Are
unstaged or late-stage cancer in institutionalized older adults observed uniformly across patients with mild or
no COG-I vs. those with moderate or severe COG-I? How do these patterns vary by MM complexity? Does
EOL care vary by COG-I gradients; by prognosis for poor survival; by race/ethnicity? What are the costs
associated with aggressive EOL care?
 We aim to investigate the above research questions using the unique, newly developed data resource
linking Surveillance, Epidemiology and End Results (SEER), Medicare, and nursing home Minimum Data Set
(MDS). To capture cancers with varying case-fatality rates, our study population will include patients with
incident or prevalent leukemias, breast, colorectal, lung, prostate, or pancreatic cancer. Our specific aims are
to: 1) characterize NH cancer patients by gradients of COG-I and complex MM phenotypes (specific
combinations of conditions constituting MM) by patient age, sex, cancer incident status, cancer type, and
prognosis, and particularly by race/ethnicity; 2) analyze patterns of unstaged cancer, cancer-directed care, and
aggressive EOL care relative to gradients of COG-I, complex MM, patient demographics, disease
characteristics, and prognosis; and 3) estimate the costs associated with aggressive EOL care in patients with
moderate/severe COG-I, complex MM, and poor prognosis for survival < 6 months.
 By addressing the above research questions, we will be able to inform targeted interventions to ensure that
dying NH cancer patients receive individualized and dignified care and reduce the costs associated with
unnecessary care. Thus, our findings will have a significant impact upon clinical practice and research in
geriatric oncology.

## Key facts

- **NIH application ID:** 10119412
- **Project number:** 3P30CA043703-30S4
- **Recipient organization:** CASE WESTERN RESERVE UNIVERSITY
- **Principal Investigator:** STANTON L. GERSON
- **Activity code:** P30 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $404,835
- **Award type:** 3
- **Project period:** 1997-08-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10119412

## Citation

> US National Institutes of Health, RePORTER application 10119412, Cognitive Impairment, Multimorbidity, and end-of-life care in older cancer patients (3P30CA043703-30S4). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10119412. Licensed CC0.

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