The Ohio State University, Medical Oncology (For correspondence and reprints), B424 Starling Loving Hall 320 W, 10th Avenue, Columbus, OH 43214, USA.
Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA.
J Geriatr Oncol. 2019 Jan;10(1):60-67. doi: 10.1016/j.jgo.2018.05.017. Epub 2018 Jun 22.
To characterize functional trajectories in the year before and after a new cancer diagnosis among older adults and to identify risk factors for worsening disability post-diagnosis.
We identified 170 participants 70+ years with monthly assessments of thirteen basic, instrumental, and mobility activities and with a new cancer diagnosis from 1998 to 2014. A group-based trajectory model identified distinct functional trajectories based on a total disability score during the twelve months pre- and post-diagnosis. We evaluated associations between potential risk factors at the time of cancer diagnosis and worsening disability post-diagnosis, explored functional transitions from pre- to post-diagnosis and identified participants whose functional trajectories worsened.
Three pre-diagnosis functional trajectories were identified among 170 participants (mean age at diagnosis: 83 years (range: 73-105 years): mild, moderate, and severe disability. Three post-diagnosis functional trajectories were identified among 158 non-decedents: mild, moderate, and severe disability. Most participants (93.9%) with severe disability pre-diagnosis had severe disability post-diagnosis. Risk factors independently associated with worsening disability post-diagnosis included moderate or severe disability pre-diagnosis (adjusted risk ratio, aRR: moderate: 2.96; 95%CI: 2.11-4.16; severe: 5.11; 95%CI: 3.07-8.52) vs. mild (reference), poor physical capability (aRR: 1.57; 95%CI: 1.07-2.30), and incurable stage (aRR:1.99; 95%CI: 1.41-2.80). 40% of participants with a mild or moderate disability trajectory pre-diagnosis transitioned to a worse functional trajectory post-diagnosis.
Older adults followed distinct functional trajectories in the twelve months before and after cancer diagnosis. Functional trajectory pre-diagnosis, poor physical capability, and incurable stage were independent risk factors for worsening disability post-diagnosis.
描述老年人在新癌症诊断前后一年的功能轨迹，并确定诊断后残疾恶化的风险因素。
我们从 1998 年至 2014 年确定了 170 名 70 岁以上的参与者，他们每月评估十三种基本、工具和移动活动，并患有新癌症诊断。基于诊断前和诊断后 12 个月的总残疾评分，使用基于群组的轨迹模型确定了不同的功能轨迹。我们评估了癌症诊断时潜在风险因素与诊断后残疾恶化之间的关联，探索了从诊断前到诊断后的功能转变，并确定了功能轨迹恶化的参与者。
在 170 名参与者中确定了三种诊断前的功能轨迹（诊断时的平均年龄：83 岁（范围：73-105 岁）：轻度、中度和重度残疾。在 158 名非死亡者中确定了三种诊断后的功能轨迹：轻度、中度和重度残疾。大多数（93.9%）诊断前患有重度残疾的参与者在诊断后也患有重度残疾。与诊断后残疾恶化独立相关的风险因素包括诊断前的中度或重度残疾（调整后的风险比，aRR：中度：2.96；95%CI：2.11-4.16；重度：5.11；95%CI：3.07-8.52）与轻度（参考）相比，身体能力差（aRR：1.57；95%CI：1.07-2.30）和不可治愈阶段（aRR：1.99；95%CI：1.41-2.80）。40%的诊断前轻度或中度残疾轨迹的参与者在诊断后转变为更差的功能轨迹。
老年人在癌症诊断前后的 12 个月中遵循不同的功能轨迹。诊断前的功能轨迹、身体能力差和不可治愈阶段是诊断后残疾恶化的独立风险因素。
