Kaiser Permanente Northern California Division of Research, Oakland.
Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington.
JAMA Oncol. 2023 Mar 1;9(3):395-403. doi: 10.1001/jamaoncol.2022.6881.
Patients with cancer experience acute declines in physical function, hypothesized to reflect accelerated aging driven by cancer-related symptoms and effects of cancer therapies. No study has examined long-term trajectories of physical function by cancer site, stage, or treatment compared with cancer-free controls.
Examine trajectories of physical function a decade before and after cancer diagnosis among older survivors and cancer-free controls.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study enrolled patients from 1993 to 1998 and followed up until December 2020. The Women's Health Initiative, a diverse cohort of postmenopausal women, included 9203 incident cancers (5989 breast, 1352 colorectal, 960 endometrial, and 902 lung) matched to up to 5 controls (n = 45 358) on age/year of enrollment and study arm.
Cancer diagnosis (site, stage, and treatment) via Medicare and medical records.
Trajectories of self-reported physical function (RAND Short Form 36 [RAND-36] scale; range: 0-100, higher scores indicate superior physical function) estimated from linear mixed effects models with slope changes at diagnosis and 1-year after diagnosis.
This study included 9203 women with cancer and 45 358 matched controls. For the women with cancer, the mean (SD) age at diagnosis was 73.0 (7.6) years. Prediagnosis, physical function declines of survivors with local cancers were similar to controls; after diagnosis, survivors experienced accelerated declines relative to controls, whose scores declined 1 to 2 points per year. Short-term declines in the year following diagnosis were most severe in women with regional disease (eg, -5.3 [95% CI, -6.4 to -4.3] points per year in regional vs -2.8 [95% CI, -3.4 to -2.3] for local breast cancer) or who received systemic therapy (eg, for local endometrial cancer, -7.9 [95% CI, -12.2 to -3.6] points per year with any chemotherapy; -3.1 [95% CI, -6.0 to -0.3] with radiation therapy alone; and -2.6 [95% CI, -4.2 to -1.0] with neither, respectively). While rates of physical function decline slowed in the later postdiagnosis period (eg, women with regional colorectal cancer declined -4.3 [95% CI, -5.9 to -2.6] points per year in the year following diagnosis vs -1.4 [95% CI, -1.7 to -1.0] points per year in the decade thereafter), survivors had estimated physical function significantly below that of age-matched controls 5 years after diagnosis.
In this prospective cohort study, survivors of cancer experienced accelerated declines in physical function after diagnosis, and physical function remained below that of age-matched controls even years later. Patients with cancer may benefit from supportive interventions to preserve physical functioning.
癌症患者经历身体功能的急性下降，这被假设反映了由癌症相关症状和癌症治疗的影响驱动的加速衰老。尚无研究比较癌症部位、阶段或治疗与无癌症对照者的身体功能的长期轨迹。
在老年幸存者和无癌症对照者中，检查癌症诊断前和诊断后 10 年的身体功能轨迹。
设计、地点和参与者：这项前瞻性队列研究纳入了 1993 年至 1998 年期间的患者，并随访至 2020 年 12 月。女性健康倡议（Women's Health Initiative）是一个由绝经后女性组成的多样化队列，包括 9203 例新发癌症（5989 例乳腺癌、1352 例结直肠癌、960 例子宫内膜癌和 902 例肺癌），根据年龄/入组年份和研究臂与多达 5 名对照者（n=45358）相匹配。
通过医疗保险和医疗记录诊断癌症（部位、阶段和治疗）。
使用线性混合效应模型估计自我报告的身体功能轨迹（RAND 短期健康调查 36 量表[RAND-36]；范围：0-100，分数越高表示身体功能越好），斜率在诊断时和诊断后 1 年发生变化。
这项研究包括 9203 例癌症患者和 45358 名匹配对照者。对于癌症患者，诊断时的平均（SD）年龄为 73.0（7.6）岁。在诊断前，局部癌症幸存者的身体功能下降与对照者相似；诊断后，幸存者的身体功能下降速度快于对照者，后者的分数每年下降 1 到 2 分。在诊断后 1 年内，疾病处于区域阶段（例如，区域乳腺癌每年下降 5.3[95%CI，-6.4 至-4.3]分）或接受全身治疗（例如，局部子宫内膜癌接受任何化疗每年下降 7.9[95%CI，-12.2 至-3.6]分；单独放疗每年下降 3.1[95%CI，-6.0 至-0.3]分；未接受任何治疗每年下降 2.6[95%CI，-4.2 至-1.0]分）的女性，短期下降最为严重。尽管在诊断后后期，身体功能下降的速度有所放缓（例如，区域结直肠癌幸存者在诊断后 1 年内每年下降 4.3[95%CI，-5.9 至-2.6]分，而在诊断后 10 年内每年下降 1.4[95%CI，-1.7 至-1.0]分），但幸存者的身体功能仍明显低于年龄匹配的对照者，甚至在诊断后 5 年也是如此。
在这项前瞻性队列研究中，癌症幸存者在诊断后身体功能加速下降，即使在几年后，身体功能仍低于年龄匹配的对照者。癌症患者可能受益于支持性干预措施来维持身体功能。
