Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
J Cachexia Sarcopenia Muscle. 2023 Aug;14(4):1670-1681. doi: 10.1002/jcsm.13247. Epub 2023 May 24.
Maintaining the ability to perform self-care is a critical goal in patients with cancer. We assessed whether the patient-reported ability to walk 4 m and wash oneself predict survival in patients with pre-terminal cancer.
We performed a prospective observational study on 169 consecutive hospitalized patients with cancer (52% female, 64 ± 12 years) and an estimated 1-12 months prognosis at an academic, inpatient palliative care unit. Patients answered functional questions for 'today', 'last week', and 'last month', performed patient-reported outcomes (PROs), and physical function assessments.
Ninety-two (54%) patients reported the ability to independently walk 4 m and 100 (59%) to wash 'today'. The median number of days patients reported the ability to walk 4 m and wash were 6 (IQR 0-7) and 7 (0-7) days ('last week'); and 27 (5-30) and 26 (10-30) days ('last month'). In the last week, 32% of patients were unable to walk 4 m on every day and 10% could walk on 1-3 days; 30% were unable to wash on every day and 10% could wash on 1-3 days. In the last months, 14% of patients were unable to walk 4 m on every day and 10% could only walk on 1-10 days; 12% were unable to wash on every day and 11% could wash on 1-10 days. In patients who could walk 'today' average 4 m gait speed was 0.78 ± 0.28 m/s. Patients who reported impaired walking and washing experienced more symptoms (dyspnoea, exertion, and oedema) and decreased physical function (higher Eastern Cooperative Oncology Group Performance Status, and lower Karnofsky Performance Status and hand-grip strength [unable vs. able to walk 'today': 205 ± 87 vs. 252 ± 78 Newton, P = 0.001; unable vs. able to wash 'today': 204 ± 86 vs. 250 ± 80 Newton, P = 0.001]). During the 27 months of observation, 152 (90%) patients died (median survival 46 days). In multivariable Cox proportional hazards regression analyses, all tested parameters were independent predictors of survival: walking 4 m 'today' (HR 0.63, P = 0.015), 'last week' (per 1 day: HR 0.93, P = 0.011), 'last month' (per 1 day: HR 0.98, P = 0.012), 4 m gait speed (per 1 m/s: HR 0.45, P = 0.002), and washing 'today' (HR 0.67, P = 0.024), 'last week (per 1 day HR 0.94, p=0.019), and 'last month' (per 1 day HR 0.99, P = 0.040). Patients unable to walk and wash experienced the shortest survival and most reduced functional status.
In patients with pre-terminal cancer, the self-reported ability to walk 4 m and wash were independent predictors of survival and associated with decreased functional status.
维持自理能力是癌症患者的一个关键目标。我们评估了患者报告的能够行走 4 米和自我清洗的能力是否可以预测处于终末期前的癌症患者的生存情况。
我们在一家学术性住院姑息治疗病房对 169 名连续住院的癌症患者（52%为女性，64±12 岁）进行了前瞻性观察性研究，并对他们在 1-12 个月内的预后进行了评估。患者回答了“今天”、“上周”和“上个月”的功能问题，进行了患者报告的结果（PROs）和身体功能评估。
92 名（54%）患者报告今天能够独立行走 4 米，100 名（59%）患者报告今天能够自己洗澡。患者报告能够行走 4 米和洗澡的天数中位数分别为 6 天（IQR 0-7）和 7 天（0-7）天（上周）；27 天（5-30 天）和 26 天（10-30 天）（上个月）。在上周，32%的患者每天都无法行走 4 米，10%的患者每天只能行走 1-3 天；30%的患者每天都无法洗澡，10%的患者每天只能洗澡 1-3 天。在上个月，14%的患者每天都无法行走 4 米，10%的患者每天只能行走 1-10 天；12%的患者每天都无法洗澡，11%的患者每天只能洗澡 1-10 天。今天能够行走 4 米的患者平均 4 米步行速度为 0.78±0.28 米/秒。报告行走和洗澡困难的患者经历了更多的症状（呼吸困难、用力和水肿）和身体功能下降（更高的东部合作肿瘤学组表现状态，以及更低的卡诺夫斯基表现状态和握力[今天能够行走：205±87 牛顿 vs. 252±78 牛顿，P=0.001；今天能够洗澡：204±86 牛顿 vs. 250±80 牛顿，P=0.001]）。在 27 个月的观察期间，152 名（90%）患者死亡（中位生存期 46 天）。在多变量 Cox 比例风险回归分析中，所有测试的参数都是生存的独立预测因素：今天行走 4 米（HR 0.63，P=0.015），上周（每天增加 1 天：HR 0.93，P=0.011），上个月（每天增加 1 天：HR 0.98，P=0.012），4 米步行速度（每增加 1 米/秒：HR 0.45，P=0.002），以及今天洗澡（HR 0.67，P=0.024），上周（每天增加 1 天：HR 0.94，P=0.019）和上个月（每天增加 1 天：HR 0.99，P=0.040）。无法行走和洗澡的患者生存时间最短，功能状态下降最明显。
在处于终末期前的癌症患者中，自我报告的行走 4 米和自我清洗的能力是生存的独立预测因素，并与功能状态下降有关。
