Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium.
J Geriatr Oncol. 2022 Nov;13(8):1162-1171. doi: 10.1016/j.jgo.2022.08.019. Epub 2022 Sep 7.
Functional status (FS) and frailty are significant concerns for older adults, especially those with cancer. Data on FS (Activities of Daily Living [ADL]; Instrumental Activities of Daily Living [IADL]) and its evolution during cancer treatment in older patients and a frailty risk profile are scarce. Therefore, this study examines FS and its evolution in older patients with cancer and a frailty risk profile and investigates characteristics associated with functional decline.
This secondary data-analysis, focusing on FS, uses data from a large prospective multicenter observational cohort study. Patients ≥70 years with a solid tumor and a frailty risk profile based on the G8 screening tool (score ≤ 14) were included. A geriatric assessment was performed including evaluation of FS based on ADL and IADL. At approximately three months of follow-up, FS was reassessed. Univariable and multivariable logistic regression analyses were used to identify predictive factors for functional decline in ADL and IADL.
Data on ADL and IADL were available at baseline and follow-up in 3388 patients. At baseline 1886 (55.7%) patients were dependent for ADL, whereas 2085 (61.5%) patients were dependent at follow-up. Functional decline was observed in 23.6% of patients. For IADL 2218 (65.5%) patients were dependent for IADL, whereas 2591 (76.5%) patients were dependent at follow-up. Functional decline in IADL was observed in 41.0% of patients. In multivariable analysis, disease stage III or IV, comorbidities, falls history in the past twelve months, and FS measured by IADL were predictive factors for functional decline in both ADL and IADL. Other predictive factors for functional decline in ADL were polypharmacy, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score 2-4, and cognitive impairment, and for functional decline in IADL were female sex, fatigue, and risk for depression.
Functional impairments are frequent in older persons with cancer and a frailty risk profile, and several characteristics are identified that are significantly associated with functional decline. Therefore, FS is an essential part of the geriatric assessment which should be standard of care for this patient population. Next step is to proceed with directed interventions with the aim to limit the risk of functional decline as much as possible.
功能状态（FS）和虚弱是老年人的重要关注点，尤其是患有癌症的老年人。有关老年人在癌症治疗期间 FS（日常生活活动[ADL]；工具性日常生活活动[IADL]）及其演变的数据以及脆弱风险概况的数据很少。因此，本研究检查了具有脆弱风险概况的老年癌症患者的 FS 及其演变，并调查了与功能下降相关的特征。
这是一项使用大型前瞻性多中心观察队列研究数据的 FS 二次数据分析。纳入了≥ 70 岁、有实体瘤和基于 G8 筛查工具（评分≤14）的脆弱风险概况的患者。进行了老年评估，包括基于 ADL 和 IADL 的 FS 评估。大约三个月的随访后，重新评估 FS。使用单变量和多变量逻辑回归分析来确定 ADL 和 IADL 功能下降的预测因素。
3388 名患者在基线和随访时提供了 ADL 和 IADL 的数据。基线时，1886 名（55.7%）患者 ADL 依赖，而 2085 名（61.5%）患者在随访时 ADL 依赖。观察到 23.6%的患者功能下降。对于 IADL，2218 名（65.5%）患者 IADL 依赖，而 2591 名（76.5%）患者在随访时 IADL 依赖。观察到 41.0%的患者 IADL 功能下降。多变量分析显示，疾病分期 III 或 IV、合并症、过去 12 个月内的跌倒史以及 IADL 测量的 FS 是 ADL 和 IADL 功能下降的预测因素。ADL 功能下降的其他预测因素包括多药治疗、东部合作肿瘤学组表现状态（ECOG-PS）评分 2-4 和认知障碍，IADL 功能下降的其他预测因素包括女性、疲劳和抑郁风险。
功能障碍在具有脆弱风险概况的老年癌症患者中很常见，并且确定了一些与功能下降显著相关的特征。因此，FS 是老年评估的重要组成部分，应成为该患者人群的护理标准。下一步是进行有针对性的干预，以尽可能降低功能下降的风险。
