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Characteristics Associated With Physical Function Trajectories in Older Adults With Cancer During Chemotherapy.

ABSTRACT: CONTEXT:Studies on physical function trajectories in older adults during chemotherapy remain limited. OBJECTIVES:The objective of this study was to determine demographic, clinical, and symptom characteristics associated with initial levels as well as trajectories of physical function over two cycles of chemotherapy in adults aged ?65 years with breast, gastrointestinal, gynecological, or lung cancer. METHODS:Older adults with cancer (n = 363) who had received chemotherapy within the preceding four weeks were assessed six times over two cycles of chemotherapy using the Short Form-12 Physical Component Summary (PCS) score. Hierarchical linear modeling was used to evaluate for interindividual variability in initial levels and trajectories of PCS scores. RESULTS:Mean age was 71.4 years (SD 5.5). Mean PCS score at enrollment was 40.5 (SD .45). On average, PCS scores decreased slightly (i.e., 0.21 points) at each subsequent assessment. Lower PCS scores at enrollment were associated with older age, greater comorbidity, being unemployed, lack of regular exercise, higher morning fatigue, lower evening energy, occurrence of pain, lower trait anxiety, and lower attentional function. Only higher morning fatigue and lower enrollment PCS scores were associated with decrements in physical function over time. CONCLUSION:While several symptoms were associated with decrements in PCS scores at enrollment in older adults with cancer receiving chemotherapy, morning fatigue was the only symptom associated with decreases in physical function over time. Regular assessments of symptoms and implementation of evidence-based interventions should be considered to maintain physical function in older adults during chemotherapy.

SUBMITTER: Wong ML

PROVIDER: S-EPMC6195841 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Characteristics Associated With Physical Function Trajectories in Older Adults With Cancer During Chemotherapy.

Wong Melisa L ML Paul Steven M SM Mastick Judy J Ritchie Christine C Steinman Michael A MA Walter Louise C LC Miaskowski Christine C

Journal of pain and symptom management 20180823 5

<h4>Context</h4>Studies on physical function trajectories in older adults during chemotherapy remain limited.<h4>Objectives</h4>The objective of this study was to determine demographic, clinical, and symptom characteristics associated with initial levels as well as trajectories of physical function over two cycles of chemotherapy in adults aged ≥65 years with breast, gastrointestinal, gynecological, or lung cancer.<h4>Methods</h4>Older adults with cancer (n = 363) who had received chemotherapy w ...[more]

PMID: 30144536

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Project description:BackgroundMaintaining functional status is important to older adults with cancer, but data are limited on how systemic treatments affect functional status. We systematically reviewed changes in functional status during systemic cancer treatments and identified characteristics associated with functional decline and improvement.MethodsWe searched PubMed, Embase, Web of Science, and Cochrane Register of Controlled Trials for articles examining characteristics associated with functional changes in older adults during systemic cancer treatment published in English between database inception and January 11, 2019 (PROSPERO CRD42019123125). Findings were summarized with descriptive statistics. Study characteristics between older adult-specific and non-older adult-specific studies were compared using the Fisher exact test.ResultsWe screened 15,244 titles/abstracts and 519 full texts. The final analysis included 44 studies, which enrolled >8,400 patients; 39% of studies focused on older adults (1 study enrolled adults aged ≥60 years, 10 enrolled adults aged ≥65 years, and 6 enrolled adults aged ≥70 years). Almost all studies (98%) used patient-reported outcomes to measure functional status; only 20% used physical performance tests. Reporting of functional change was heterogeneous, with 48% reporting change scores. Older adult-specific studies were more likely to analyze functional change dichotomously (29% vs 4%; P=.008). Functional decline ranged widely, from 6% to 90%. The most common patient characteristics associated with functional decline were older age (n=7 studies), worse performance status (n=4), progressive disease status (n=4), pain (n=4), anemia (n=4), and worse nutritional status (n=4). Twelve studies examined functional improvement and identified 11 unique associated characteristics.ConclusionsFunctional decline is increasingly recognized as an important outcome in older adults with cancer, but definitions and analyses are heterogeneous, leading to a wide range of prevalence. To identify patients at highest risk of functional decline during systemic cancer treatments, trials need to routinely analyze functional outcomes and measure characteristics associated with decline (eg, nutrition).

Dataset Information

Characteristics Associated With Physical Function Trajectories in Older Adults With Cancer During Chemotherapy.

Publications

Characteristics Associated With Physical Function Trajectories in Older Adults With Cancer During Chemotherapy.

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