[en] [en] INTRODUCTION: Functional status (FS) and frailty are significant concerns for older adults, especially those with cancer. Data on FS (Activities of Daily Living [ADL]; Instrumental Activities of Daily Living [IADL]) and its evolution during cancer treatment in older patients and a frailty risk profile are scarce. Therefore, this study examines FS and its evolution in older patients with cancer and a frailty risk profile and investigates characteristics associated with functional decline.
MATERIAL AND METHODS: This secondary data-analysis, focusing on FS, uses data from a large prospective multicenter observational cohort study. Patients ≥70 years with a solid tumor and a frailty risk profile based on the G8 screening tool (score ≤ 14) were included. A geriatric assessment was performed including evaluation of FS based on ADL and IADL. At approximately three months of follow-up, FS was reassessed. Univariable and multivariable logistic regression analyses were used to identify predictive factors for functional decline in ADL and IADL.
RESULTS: Data on ADL and IADL were available at baseline and follow-up in 3388 patients. At baseline 1886 (55.7%) patients were dependent for ADL, whereas 2085 (61.5%) patients were dependent at follow-up. Functional decline was observed in 23.6% of patients. For IADL 2218 (65.5%) patients were dependent for IADL, whereas 2591 (76.5%) patients were dependent at follow-up. Functional decline in IADL was observed in 41.0% of patients. In multivariable analysis, disease stage III or IV, comorbidities, falls history in the past twelve months, and FS measured by IADL were predictive factors for functional decline in both ADL and IADL. Other predictive factors for functional decline in ADL were polypharmacy, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score 2-4, and cognitive impairment, and for functional decline in IADL were female sex, fatigue, and risk for depression.
DISCUSSION: Functional impairments are frequent in older persons with cancer and a frailty risk profile, and several characteristics are identified that are significantly associated with functional decline. Therefore, FS is an essential part of the geriatric assessment which should be standard of care for this patient population. Next step is to proceed with directed interventions with the aim to limit the risk of functional decline as much as possible.
Disciplines :
Oncology
Author, co-author :
Meert, Glen; Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
Kenis, Cindy; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium, Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
Milisen, Koen; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
Debruyne, Philip R; Department of Medical Oncology, Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium, Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
De Groof, Inge; Department of Geriatric Medicine, St. Augustinus, Wilrijk, Belgium
Focan, Christian; Department of Oncology, Clinique CHC Montlégia, Liège, Belgium
Cornélis, Frank; Department of Medical Oncology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
Verschaeve, Vincent; Department of Medical Oncology, GHDC Grand Hôpital de Charleroi, Charleroi, Belgium
Bachmann, Christian; Department of Geriatric Medicine, AZ Sint-Lucas, Gent, Belgium
Bron, Dominique; Department of Hematology, ULB Institut Jules Bordet, Brussels, Belgium
Den Bulck, Heidi Van; Department of Medical Oncology, Imelda Hospital, Bonheiden, Belgium
Schrijvers, Dirk; Department of Medical Oncology, ZNA Middelheim, Antwerp, Belgium
Langenaeken, Christine; Department Medical Oncology, Iridium Cancer Network Antwerp, AZ Klina, Brasschaat, Belgium
Specenier, Pol; Department of Medical Oncology, University Hospital Antwerp, Antwerp, Belgium
Jerusalem, Guy ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'oncologie médicale
Praet, Jean-Philippe; Department of Geriatric Medicine, CHU St-Pierre, Free Universities Brussels, Brussels, Belgium
Lobelle, Jean-Pierre; Consultant in Statistics, Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
Flamaing, Johan; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium, Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven - University of Leuven, Leuven, Belgium
Wildiers, Hans; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium, Department of Oncology, KU Leuven, Leuven, Belgium
Decoster, Lore; Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: lore.decoster@uzbrussel.be
HW is a recipient of a grant of the ‘Fonds Voor Wetenschappelijk Onderzoek Vlaanderen’ (1802211 N).This study was funded by the Cancer Plan 2012-2015, a grant provided by the Federal Public Service of Health, Food Chain Safety and Environment, Belgium (KPC_24_A_025).
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