Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA.
Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA.
J Pain Symptom Manage. 2018 Nov;56(5):678-688.e1. doi: 10.1016/j.jpainsymman.2018.08.006. Epub 2018 Aug 23.
Studies on physical function trajectories in older adults during chemotherapy remain limited.
The objective of this study was to determine demographic, clinical, and symptom characteristics associated with initial levels as well as trajectories of physical function over two cycles of chemotherapy in adults aged ≥65 years with breast, gastrointestinal, gynecological, or lung cancer.
Older adults with cancer (n = 363) who had received chemotherapy within the preceding four weeks were assessed six times over two cycles of chemotherapy using the Short Form-12 Physical Component Summary (PCS) score. Hierarchical linear modeling was used to evaluate for interindividual variability in initial levels and trajectories of PCS scores.
Mean age was 71.4 years (SD 5.5). Mean PCS score at enrollment was 40.5 (SD .45). On average, PCS scores decreased slightly (i.e., 0.21 points) at each subsequent assessment. Lower PCS scores at enrollment were associated with older age, greater comorbidity, being unemployed, lack of regular exercise, higher morning fatigue, lower evening energy, occurrence of pain, lower trait anxiety, and lower attentional function. Only higher morning fatigue and lower enrollment PCS scores were associated with decrements in physical function over time.
While several symptoms were associated with decrements in PCS scores at enrollment in older adults with cancer receiving chemotherapy, morning fatigue was the only symptom associated with decreases in physical function over time. Regular assessments of symptoms and implementation of evidence-based interventions should be considered to maintain physical function in older adults during chemotherapy.
关于老年人在化疗期间身体功能轨迹的研究仍然有限。
本研究的目的是确定与≥65 岁患有乳腺癌、胃肠道癌、妇科癌或肺癌的成年人在两个化疗周期中身体功能初始水平以及轨迹相关的人口统计学、临床和症状特征。
在过去四周内接受过化疗的癌症老年患者（n=363）在两个化疗周期中接受了六次评估，使用简式健康调查量表 12 项（Short Form-12）生理成分综合评分（PCS）进行评估。采用分层线性模型评估个体间 PCS 评分初始水平和轨迹的变异性。
平均年龄为 71.4 岁（SD 5.5）。入组时 PCS 平均得分为 40.5（SD.45）。平均而言，PCS 评分在每次后续评估中略有下降（即 0.21 分）。入组时较低的 PCS 评分与年龄较大、合并症较多、失业、缺乏规律运动、较高的早晨疲劳、较低的傍晚精力、疼痛发生、较高的特质焦虑和较低的注意力功能相关。只有较高的早晨疲劳和较低的初始 PCS 评分与身体功能随时间的下降有关。
虽然化疗期间接受化疗的癌症老年患者的几个症状与 PCS 评分下降有关，但早晨疲劳是唯一与身体功能随时间下降相关的症状。应定期评估症状并实施基于证据的干预措施，以维持化疗期间老年患者的身体功能。
