Jensen-Battaglia Marielle, Delmerico Alan, Mohamed Mostafa, Tylock Rachael, Flannery Marie, Burnette Brian L, Desai Nisarg, Anthony Navin, Mustian Karen, Loh Kah Poh, Mohile Supriya G, Seplaki Christopher L, Gilmore Nikesha
James P. Wilmot Cancer Institute, 601 Elmwood Ave, Rochester, NY 14642, United States of America; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, Rochester, NY 14642, United States of America.
Center for Health and Social Research, Buffalo State University, 1300 Elmwood Ave, Buckham Hall A100, Buffalo, NY 14222, United States of America.
J Geriatr Oncol. 2025 Jul;16(6):102284. doi: 10.1016/j.jgo.2025.102284. Epub 2025 May 31.
INTRODUCTION: Older adults with cancer-related fatigue often experience impairments in their physical function. Social determinants of health (SDOH) at the individual and community level may mean some patients have fewer resources to deal with fatigue and are at greater risk for decline in physical function. MATERIALS AND METHODS: We analyzed patients age ≥ 70 with advanced cancer and ≥ 1 aging-related impairment who were starting new treatment regimens with a high risk of toxicity in a nationwide cluster-randomized clinical trial (NCT02054741, UG1CA189961). Patient-Reported Outcome Common Terminology Criteria for Adverse Events (PROC-CTCAE) fatigue severity (0-4 points) was collected at baseline, Short Physical Performance Battery (SPPB, a measure of physical function, 0-12 points) at baseline, 4-6 weeks, 3 months, and 6 months. SDOH in the county where patients lived were measured by the Social Vulnerability Index (SVI, a measure reflecting community vulnerability, 0 to 1, higher = worse). We estimated adjusted relative risk (RR) of ≥1 point SPPB decline at 4-6 weeks associated with baseline fatigue. In exploratory analyses we estimated: (1) this association at 3 and 6 months, (2) moderation of this association by SVI. RESULTS: Out of 718 patients, we analyzed 600 with SPPB assessed at ≥1 follow up timepoint. Half reported fatigue that was moderate or greater, and 38.8 % declined in SPPB by 4-6 weeks. Mean SVI was 0.42 (SD 0.23). Greater fatigue was associated with increased risk of SPPB decline at 4-6 weeks (RR 1.21; 95 % CI 1.09, 1.34, p < 0.001), but not 3 or 6 months. The association at 4-6 weeks was not significantly different for patients living in areas with the least vulnerable quartile of SVI (RR 1.27, 95 % CI 1.05, 1.53) vs. the most vulnerable (RR 1.22, 95 % CI 0.91, 1.65; p = 0.85). DISCUSSION: Fatigue is associated with decline in physical function among older adults with advanced cancer and does not vary by social vulnerability. These results emphasize the importance of assessing and managing fatigue in this population.
引言：患有癌症相关疲劳的老年人身体功能常常受损。个体和社区层面的健康社会决定因素（SDOH）可能意味着一些患者应对疲劳的资源较少，身体功能下降的风险更大。 材料与方法：在一项全国性整群随机临床试验（NCT02054741，UG1CA189961）中，我们分析了年龄≥70岁、患有晚期癌症且存在≥1种与衰老相关损伤、开始新的具有高毒性风险治疗方案的患者。在基线时收集患者报告的不良事件通用术语标准疲劳严重程度（PROC-CTCAE，0 - 4分），在基线、4 - 6周、3个月和6个月时收集简短体能状况量表（SPPB，一种身体功能测量指标，0 - 12分）。通过社会脆弱性指数（SVI，一种反映社区脆弱性的测量指标，0至1，分数越高越差）来衡量患者居住县的健康社会决定因素。我们估计了与基线疲劳相关的4 - 6周时SPPB下降≥1分的调整相对风险（RR）。在探索性分析中，我们估计了：（1）3个月和6个月时的这种关联，（2）SVI对这种关联的调节作用。 结果：在718名患者中，我们分析了600名在≥1个随访时间点进行了SPPB评估的患者。一半患者报告有中度或更严重的疲劳，38.8%的患者在4 - 6周时SPPB下降。平均SVI为0.42（标准差0.23）。更严重的疲劳与4 - 6周时SPPB下降风险增加相关（RR = 1.21；95%置信区间1.09，1.34，p < 0.001），但在3个月或6个月时无此关联。对于生活在SVI最不脆弱四分位数区域的患者，4 - 6周时的关联与最脆弱区域的患者相比无显著差异（RR = 1.27，95%置信区间1.05，1.53）与（RR = 1.22，95%置信区间0.91，1.65；p = 0.85）。 讨论：疲劳与晚期癌症老年患者的身体功能下降相关，且不因社会脆弱性而有所不同。这些结果强调了在这一人群中评估和管理疲劳的重要性。
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