Factors associated with ADL-defined disability-free survival among patients with advanced cancer in a palliative care setting: a retrospective cohort study.

OBJECTIVES

Disability-free survival (DFS) focusing on essential activities of daily living (ADL) is a critical outcome for patients with advanced cancer receiving palliative care, yet remains underexplored. This study aimed to examine DFS for core ADL components (eating, toileting, and walking) in patients admitted to the palliative care unit (PCU) and to identify associated factors using a competing risk model. Understanding these factors may guide targeted interventions to preserve functional independence and enhance quality of life.

METHODS

This retrospective cohort study included advanced cancer patients admitted to the PCU between August 2018 and September 2022, excluding those discharged home. The primary endpoint was DFS, defined as the period from admission to an event resulting in a Functional Independence Measure (FIM™) score below 6 in eating, toileting, or walking. FIM™ is a widely used tool for assessing functional independence across multiple domains. DFS was estimated using a competing risk model to account for death as a competing event, and Fine–Gray regression analysis was conducted to identify factors associated with DFS.

RESULTS

A total of 143, 48, and 46 patients were analyzed for eating, toileting, and walking, respectively. The median DFS (95% confidence interval) was 4 (3–5) weeks for eating, 3.5 (3–6) weeks for toileting, and 3 (2–6) weeks for walking. Cognitive function (FIM™ cognitive items) and the cachexia (modified Glasgow Prognostic Score) at admission were commonly associated with DFS. Neutrophil-to-lymphocyte ratio was specifically associated with DFS for eating, and bone and liver metastases were associated with DFS for toileting and walking.

CONCLUSIONS

Monitoring ADL-defined DFS and key factors such as cognitive function and inflammation-nutritional status may enable timely interventions, optimize care strategies, and support quality of life for patients with advanced cancer in palliative care settings. Future studies could explore prospective validation of these findings and investigate whether early interventions targeting these factors can extend disability-free survival. In addition, integrating rehabilitation strategies and routine cognitive assessments may further enhance the benefits of individualized care in this population.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12904-025-01847-7.