Nam Gina E, Mayeda Elizabeth Rose, Pan Yancen, Hayes-Larson Eleanor, Rojas-Saunero L Paloma, Zhou Hua, Rao Jian Yu, Zhang Zuo-Feng
Department of Epidemiology, UCLA Fielding School of Public Health, 71-225 CHS, 650 Charles E. Young Drive South, Box 951772, Los Angeles, CA, 90095-1772, USA.
Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
J Cancer Surviv. 2025 Jul 29. doi: 10.1007/s11764-025-01867-5.
We conducted a longitudinal secondary data analysis to estimate long-term functional limitation trajectories of adults over 50 with cancer compared to cancer-free individuals.
Using the Health and Retirement Study (1998-2020), we followed adults over 50 without cancer history. Incident cancer was self-reported or proxy reported. Functional decline was assessed using self-reported independence in six domains, including instrumental activities of daily living (IADL), activities of daily living (ADL), mobility, large muscle, gross motor, and fine motor skills. We employed linear probability models with repeated measures to estimate independence probabilities.
Among 15,972 participants (mean [SD] age, 66.1 [9.9] years), 23.1% reported cancer during follow-up. Before diagnosis, individuals with cancer had a 1.3% lower probability of IADL independence compared to cancer-free individuals (95% CI = - 1.9, - 0.7). After diagnosis, cancer survivors experienced a sharp 6% drop in IADL independence, resulting in a 3.4% lower probability than in those without cancer (- 4.6, - 2.2). The annual rate of IADL decline after diagnosis was slower in cancer survivors compared to those without cancer (- 0.9% vs. - 1.3%). Similar patterns were observed for ADL. The greatest immediate reduction was in the gross motor domain with a decline of 8.6% (- 10.4, - 6.8).
Cancer survivors experienced rapid functional decline at diagnosis, possibly attributed to active treatment. Following diagnosis, cancer survivors had a more gradual loss in functional independence compared to cancer-free individuals.
Findings underscore the importance of proactive, tailored interventions to support functional independence in older cancer survivors, particularly around diagnosis.
我们进行了一项纵向二次数据分析，以估计50岁以上癌症患者与无癌症个体相比的长期功能受限轨迹。
利用健康与退休研究（1998 - 2020年），我们追踪了50岁以上无癌症病史的成年人。新发癌症通过自我报告或他人代报。使用自我报告的六个领域的独立性来评估功能下降，包括工具性日常生活活动（IADL）、日常生活活动（ADL）、 mobility、大肌肉、粗大运动和精细运动技能。我们采用具有重复测量的线性概率模型来估计独立概率。
在15972名参与者（平均[标准差]年龄，66.1[9.9]岁）中，23.1%在随访期间报告患癌症。在诊断前，癌症患者IADL独立的概率比无癌症个体低1.3%（95%CI = - 1.9， - 0.7）。诊断后，癌症幸存者IADL独立性急剧下降6%，导致比无癌症者低3.4%（- 4.6， - 2.2）。与无癌症者相比，癌症幸存者诊断后IADL下降的年率较慢（- 0.9%对 - 1.3%）。ADL也观察到类似模式。最大的即时下降出现在粗大运动领域，下降了8.6%（- 10.4， - 6.8）。
癌症幸存者在诊断时经历了快速的功能下降，可能归因于积极治疗。诊断后，与无癌症个体相比，癌症幸存者在功能独立性方面的丧失更为缓慢。
研究结果强调了积极主动、量身定制的干预措施对于支持老年癌症幸存者功能独立性的重要性，特别是在诊断前后。
