Background:Performance status, a predictor of cancer survival, and ability to maintain
independent living deteriorate in advanced disease. Understanding predictors
of performance status trajectory could help identify those at risk of
functional deterioration, target support for independent living and reduce
service costs. The relationship between symptoms, analgesics and performance
status is poorly delineated.Aim:The aim of this study is to determine whether demographics, analgesics,
disease characteristics, quality-of-life domains and C-reactive protein
predict the trajectory of Karnofsky Performance Status (KPS) in patients
with advanced cancer.Design:The study design is the secondary data analysis of the international
prospective, longitudinal European Palliative Care Cancer Symptom study
(ClinicalTrials.gov: NCT01362816). A multivariable regression model was
built for KPS area under the curve per day (AUC).Setting and participants:This included adults with advanced, incurable cancer receiving palliative
care, without severe cognitive impairment and who were not imminently dying
(n = 1739).Results:The mean daily KPS AUC (n = 1052) was 41.1 (standard
deviation = 14.1). Opioids (p < 0.001), co-analgesics
(p = 0.023), poorer physical functioning
(p < 0.001) and appetite loss
(p = 0.009) at baseline were explanatory factors for lower
KPS AUC. A subgroup analysis of participants with C-reactive protein data
(n = 240) showed that only C-reactive protein
(p = 0.040) and physical function
(p < 0.001) were associated with lower KPS AUC.Conclusion:This study is novel in determining explanatory factors for subsequent
functional trajectories in an international dataset and identifying systemic
inflammation as a candidate therapeutic target to improve functional
performance. The effect of interventions targeting physical function,
appetite and inflammation, such as those used for cachexia management, on
maintaining functional status in patients with advanced cancer needs to be
investigated.