Qin Evelyn S, Richards Blair, Smith Sean R
Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
Michigan Institute for Clinical Health Research, University of Michigan, Ann Arbor, MI 48109, USA.
Cancers (Basel). 2023 Jul 6;15(13):3515. doi: 10.3390/cancers15133515.
Patients with cancer often experience changes in function during and after treatment but it is not clear what cancer types, and associated clinical factors, affect function. This study evaluated patient-reported functional impairments between specific cancer types and risk factors related to disease status and non-cancer factors. A cross-sectional study evaluating 332 individuals referred to cancer rehabilitation clinics was performed at six U.S. hospitals. The PROMIS Cancer Function Brief 3D Profile was used to assess functional outcomes across the domains of physical function, fatigue, and social participation. Multivariable modeling showed an interaction between cancer type and cancer status on the physical function and social participation scales. Subset analyses in the active cancer group showed an effect by cancer type for physical function ( < 0.001) and social participation ( = 0.008), but no effect was found within the non-active cancer subset analyses. Brain, sarcoma, prostate, and lymphoma were the cancers associated with lower function when disease was active. Premorbid neurologic or musculoskeletal impairments were found to be predictors of lower physical function and social participation in those with non-active cancer; cancer type did not predict low function in patients with no evidence of disease. There was no differential effect of cancer type on fatigue, but increased fatigue was significantly associated with lower age (0.027), increased body mass index ( < 0.001), premorbid musculoskeletal impairment ( < 0.015), and active cancer status ( < 0.001). Anticipatory guidance and education on the common impairments observed with specific cancer types and during specific stages of cancer care may help improve/support patients and their caregivers as they receive impairment-driven cancer rehabilitation care.
癌症患者在治疗期间及之后常出现功能变化，但尚不清楚哪些癌症类型以及相关临床因素会影响功能。本研究评估了特定癌症类型之间患者报告的功能障碍以及与疾病状态和非癌症因素相关的风险因素。在美国六家医院开展了一项横断面研究，评估了332名转诊至癌症康复诊所的个体。使用PROMIS癌症功能简要3D概况来评估身体功能、疲劳和社会参与等领域的功能结局。多变量建模显示，癌症类型与癌症状态在身体功能和社会参与量表上存在相互作用。活跃癌症组的亚组分析显示，癌症类型对身体功能（<0.001）和社会参与（=0.008）有影响，但在非活跃癌症亚组分析中未发现影响。当疾病活跃时，脑癌、肉瘤、前列腺癌和淋巴瘤是与功能较低相关的癌症。病前神经或肌肉骨骼损伤被发现是无活跃癌症患者身体功能和社会参与较低的预测因素；癌症类型并不能预测无疾病证据患者的低功能。癌症类型对疲劳没有差异影响，但疲劳增加与年龄较小（0.027）、体重指数增加（<0.001）、病前肌肉骨骼损伤（<0.015）和活跃癌症状态（<0.001）显著相关。针对特定癌症类型以及癌症治疗特定阶段常见损伤的预期指导和教育，可能有助于改善/支持患者及其护理人员接受以损伤为导向的癌症康复护理。
