Brick Rachelle, Jensen-Battaglia Marielle, Streck Brennan P, Page Lindsey, Tylock Rachael, Cacciatore Jenna, Mustian Karen, Khatri Jamil, Giguere Jeff, Dib Elie G, Mohile Supriya, Culakova Eva
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA.
J Am Geriatr Soc. 2025 Jan;73(1):136-149. doi: 10.1111/jgs.19250. Epub 2024 Nov 2.
Older adults with advanced cancer experience functional disability that warrants rehabilitation services; however, evidence indicates inconsistencies in referral. The purpose was to (1) identify predictors of geriatric assessment (GA)-driven referrals to rehabilitation services and (2) explore associations between referral and change in function, health-related quality of life (HRQoL), and overall survival among older adults with advanced cancer.
This was a secondary analysis (NCT020107443, UG1CA189961) of a nationwide GA clinical trial. Patients were older adults with advanced cancer who had at least one GA-defined physical performance or functional status impairment. Primary outcomes were oncologist-initiated discussion about or referral to rehabilitation services after the GA (Aim 1) and decline in activities of daily living (ADL), Instrumental ADL (IADL), and HRQoL within 3 months, and overall survival at 1 year (Exploratory Aims). Analyses included multivariable logistic regression and Cox proportional hazards models. Demographic and clinical factors were controlled for by using 1:1 propensity score matching.
In total 265 patients were analyzed. After adjustment, impaired cognition (odds ratio [OR] = 2.25, p = 0.01), Karnofsky score indicating disability (OR = 2.86, p < 0.01), and receipt of monoclonal antibodies (OR = 1.95, p = 0.04) were associated with higher odds of referral. In contrast, polypharmacy was associated with lower odds of referral (OR = 0.31, p < 0.01). Referred patients were less likely to decline in ADL (OR 0.30, p = 0.07) and IADL (OR 0.64, p = 0.35), but more likely to decline in HRQoL (OR 1.20, p = 0.67) and have worse survival (HR 1.18, p = 0.62).
Cancer treatment, polypharmacy, cognition, and disability status likely influence oncologists' decision to refer for rehabilitation. Referral was not independently associated with change in functional disability, HRQoL, or survival. Future studies should evaluate patients' utilization of rehabilitation services post-referral and determine whether dose/timing of rehabilitation services influence clinical outcomes.
患有晚期癌症的老年人存在功能障碍，需要康复服务；然而，证据表明转诊存在不一致性。目的是：（1）确定老年评估（GA）驱动的康复服务转诊的预测因素；（2）探讨转诊与晚期癌症老年人功能变化、健康相关生活质量（HRQoL）和总生存期之间的关联。
这是一项对全国性GA临床试验的二次分析（NCT020107443，UG1CA189961）。患者为患有晚期癌症的老年人，至少存在一项GA定义的身体活动能力或功能状态受损。主要结局为GA后肿瘤学家发起的关于康复服务的讨论或转诊（目标1），以及3个月内日常生活活动（ADL）、工具性ADL（IADL）和HRQoL的下降，和1年时的总生存期（探索性目标）。分析包括多变量逻辑回归和Cox比例风险模型。通过1:1倾向评分匹配控制人口统计学和临床因素。
共分析了265例患者。调整后，认知障碍（比值比[OR]=2.25，p=0.01）、表明存在残疾的卡氏评分（OR=2.86，p<0.01）和接受单克隆抗体治疗（OR=1.95，p=0.04）与更高的转诊几率相关。相比之下，多重用药与更低的转诊几率相关（OR=0.31，p<0.01）。转诊患者ADL下降的可能性较小（OR 0.30，p=0.07）和IADL下降的可能性较小（OR 0.64，p=0.35），但HRQoL下降的可能性较大（OR 1.20，p=0.67）且生存情况较差（风险比1.18，p=0.62）。
癌症治疗、多重用药、认知和残疾状态可能影响肿瘤学家的康复转诊决策。转诊与功能障碍、HRQoL或生存期的变化无独立关联。未来研究应评估患者转诊后对康复服务的利用情况，并确定康复服务的剂量/时机是否影响临床结局。
