Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Cancer Prevention Fellowship Program, Division of Cancer Prevention, NCI, Rockville, Maryland.
Cancer Epidemiol Biomarkers Prev. 2021 Apr;30(4):690-698. doi: 10.1158/1055-9965.EPI-20-1473. Epub 2021 Mar 4.
There is limited evidence describing associations between cancer and function in diverse cancer types and its relationship with mortality. We investigated the relationship between cancer and poor ambulatory function and associations between ambulatory function and subsequent mortality.
Participants included 233,135 adults ( = 30,403 cancer and = 202,732 cancer free) in the NIH-American Association of Retired Persons Diet and Health Study (1994-1996) who self-reported ambulatory function (e.g., walking pace and mobility disability: being unable to walk or walking at the slowest pace) in 2004-2006. Participants were followed for mortality from the assessment of ambulatory function through 2011. Multinomial logistic regression quantified the association between cancer and ambulatory function. We then explored the independent effects of walking pace and mobility disability in cancer survivors, and the joint effects of both a cancer diagnosis and poor ambulatory function on mortality using Cox proportional hazards models. Models explored type-specific associations across 15 cancer types.
Survivors had 42% greater odds of walking at the slowest pace [OR, 1.42 (confidence interval (CI), 1.30-1.54)] and 24% greater odds of mobility disability [OR, 1.24 (CI, 1.17-1.31)], compared with cancer-free participants, adjusting for baseline demographics, health indicators, and cancer type. Survivors reporting the slowest pace were at increased hazards than those who walked the fastest: all-cause mortality [HR, 2.22 (CI, 2.06-2.39)] and cancer mortality [HR, 2.12 (CI, 1.83-2.45)]. Similar trends emerged for mobility disability (HRs > 1.64). All-cause mortality associations were significant for more than nine cancer types.
A diagnosis of cancer is associated with poorer ambulatory function, which is subsequently associated with increased mortality.
Widespread efforts should target ambulatory function during cancer survivorship for survival benefits.
目前针对不同癌症类型中癌症与功能之间的关联及其与死亡率的关系，仅有有限的证据。我们调查了癌症与较差的走动功能之间的关系，并探讨了走动功能与随后死亡率之间的关联。
我们的研究对象为 NIH-美国退休人员协会饮食与健康研究（1994-1996 年）中的 233135 名成年人（=30403 例癌症患者和=202732 例无癌症患者），他们在 2004-2006 年报告了自己的走动功能（例如，行走速度和移动障碍：无法行走或以最慢的速度行走）。参与者从评估走动功能开始，随访至 2011 年的死亡情况。多项逻辑回归量化了癌症与走动功能之间的关联。然后，我们在癌症幸存者中探讨了行走速度和移动障碍的独立影响，以及癌症诊断和较差的走动功能对死亡率的联合影响，使用 Cox 比例风险模型。模型通过 15 种癌症类型探索了特定类型的关联。
与无癌症患者相比，幸存者行走速度最慢的可能性要高出 42%[比值比（OR），1.42（置信区间（CI），1.30-1.54）]，移动障碍的可能性要高出 24%[OR，1.24（CI，1.17-1.31）]，调整了基线人口统计学、健康指标和癌症类型。与行走最快的幸存者相比，报告行走速度最慢的幸存者发生全因死亡[风险比（HR），2.22（CI，2.06-2.39）]和癌症死亡[HR，2.12（CI，1.83-2.45）]的风险更高。移动障碍也出现了类似的趋势（HRs >1.64）。超过 9 种癌症类型的全因死亡率关联均具有统计学意义。
癌症诊断与较差的走动功能相关，而较差的走动功能与死亡率增加相关。
广泛的努力应该针对癌症生存期间的走动功能，以获得生存获益。
