Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
Institute for Healthcare Policy and Innovations, University of Michigan, Ann Arbor, Michigan, USA.
J Cancer Surviv. 2023 Oct;17(5):1499-1509. doi: 10.1007/s11764-022-01185-0. Epub 2022 Feb 26.
We aimed to identify prototypical functional aging trajectories of US cancer survivors aged 50 and older, overall and stratified by sociodemographic and health-related characteristics.
Data were from 2986 survivors of a first incident cancer diagnosis (except non-melanoma skin cancer) after age 50 in the population representative U.S. Health and Retirement Study from 1998-2016. Cancer diagnoses, episodic memory function, and activity of daily living (ADL) limitations were assessed at biennial study interviews. Using time of cancer diagnosis as the baseline, we used group-based trajectory modeling to identify trajectories of memory function and ADL limitations following diagnosis.
We identified five memory loss trajectories (high: 8.4%; medium-high: 18.3%; medium-low: 21.5%; low: 25.5%; and, very low: 26.2%), and four ADL limitation trajectories (high/increasing limitations: 18.7%; medium limitations: 18.7%; low limitations: 8.14%; no limitations: 60.0). The high memory loss and high/increasing ADL limitation trajectories were both characterized by older age, being female (52% for memory, 58.9% for ADL), having lower pre-cancer memory scores, and a higher prevalence of pre-cancer comorbidities including stroke (30.9% for memory and 29.7% for ADL), hypertension (64.7% for memory and 69.8 for ADL), and depressive symptoms. In joint analyses, we found that generally those with higher memory were more likely to have fewer ADL limitations and vice versa.
Older cancer survivors experience heterogeneous trajectories of functional aging that are largely characterized by comorbidities prior to diagnosis.
Results can help identify older cancer survivors at increased risk for accelerated functional decline.
我们旨在确定美国 50 岁及以上癌症幸存者的典型功能老化轨迹，总体上和按社会人口统计学和与健康相关的特征进行分层。
数据来自美国健康与退休研究中 1998-2016 年期间年龄在 50 岁以上的首次癌症诊断（非黑色素瘤皮肤癌除外）的 2986 名幸存者。在每两年一次的研究访谈中评估癌症诊断、情景记忆功能和日常生活活动（ADL）限制。使用癌症诊断时间作为基线，我们使用基于群组的轨迹建模来确定诊断后记忆功能和 ADL 限制的轨迹。
我们确定了五个记忆丧失轨迹（高：8.4%；中高：18.3%；中低：21.5%；低：25.5%；和非常低：26.2%）和四个 ADL 限制轨迹（高/增加限制：18.7%；中限：18.7%；低限：8.14%；无限制：60.0%）。高记忆丧失和高/增加 ADL 限制轨迹均以年龄较大、女性（记忆占 52%，ADL 占 58.9%）、癌症前记忆评分较低以及癌症前合并症（记忆占 30.9%，ADL 占 29.7%）的发生率较高为特征，包括中风、高血压（记忆占 64.7%，ADL 占 69.8%）和抑郁症状。在联合分析中，我们发现一般来说，记忆力较高的人更有可能 ADL 限制较少，反之亦然。
老年癌症幸存者经历功能老化的异质轨迹，主要由诊断前的合并症特征。
结果可以帮助确定功能下降加速风险较高的老年癌症幸存者。
