Predictors of Unhealthy Days in Patients with Metastatic Breast, Lung, Or Colorectal Cancer

This study investigates correlates of patient reported unhealthy days (unHD) in a Humana mostly Medicare cancer cohort undergoing chemotherapy. In 2015, surveys were mailed to 7,432 patients with metastatic breast, lung or colorectal cancer > 1 comorbid conditions and treated for cancer within 3 months. The Center for Disease Control and Prevention’s Healthy Days measure assessed self-reported unHD in the past 30 days. Levels of cancer-related symptoms [pain, fatigue, shortness of breath (SB) and hair loss] in the past 30 days were reported on 5-point Likert scales. Comorbidity Medication Adherence (CMA) was assessed using the 8-point Morisky Medication Adherence Scale and described as low (<6) or high (>=6). Depression was identified in medical claims (ICD-9-CM 311). Negative-binomial regression controlling for age, gender, Deyo-Charlson Comorbidity Index and cancer type was used to assess factors associated with unHD and was presented as rate ratios (95% confidence intervals). The survey response rate was 25% (n=1,847). 67% of patients were female; 88% Medicare; mean age was 69.2+/-9.2. In the multivariable models, patients with pain had 85% more unHD than patients without pain [1.85 (1.59-2.21); p=<0.0001]; patients with fatigue had 102% more unHD than patients without fatigue [2.02 (1.72-2.37); p=<0.0001]; patients with SB has 30% more unHD than those without SB, [1.30 (1.12-1.51); p=0.0005]. Patients with low CMA had 18% more unHD than those with high CMA [1.18 (1.01-1.39); p=0.0429]. Depressed patients had 18% more unHD than those without depression [1.18 (1.01 – 1.37; p=0.0384]. Those dually eligible for Medicare/Medicaid had 42% more unHD than those not dually eligible, [1.42 (1.05-1.92); p=0.0243]. CMA, depression and Medicaid status were associated with patient-reported unHD. Patient-reported cancer-related symptoms, most notably pain and fatigue, were most predictive of unhealthy days. Interventions aimed at ameliorating these symptoms may improve quality of life for cancer patients.