Characteristics Associated With Functional Changes During Systemic Cancer Treatments: A Systematic Review Focused on Older Adults

Abstract

Background: Maintaining 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. Methods: We 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. Results: We 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. Conclusions: Functional 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).

Development and Evaluation of a Multimodal Supportive Intervention for Promoting Physical Function in Older Patients with Cancer

“…Complementary to group-based MV and SD, especially in small samples such as our study, individual trajectories of PF (e.g., spaghetti plots) may complement quantitative data and allow a more case-based approach revealing individual conditions including possible associations e.g., between PF, symptom burden and the disease trajectory. Results of studies [ 69 , 70 , 71 ] and our findings highlight the relevance of repeated assessments of patient-reported symptoms to optimize supportive therapy during after care. As functional decline may impact HRQOL and selfcare, maintenance of PF constitutes a task for the multiprofessional team [ 72 ].…”

“…In cross-sectional studies, Chen et al reported inverse correlations of symptom clusters (e.g., pain, fatigue, sleep and nutrition related symptoms) with physical function [ 69 ] and Pandya et al reported associations between high symptom burden with limitations of physical function, IADL impairments and falls [ 70 ]. Loh et al, in a recent review focusing on functional changes in older adults undergoing systemic cancer treatments, reported associations between functional decline and progressive disease status, pain, anemia and worse nutritional status [ 71 ].…”

Changes in older adults' life space during lung cancer treatment: A mixed methods cohort study

“…Maintenance of function during treatment is critically important to older adults with cancer 6 . Yet, studies of functional changes during NSCLC treatment among older adults remain limited 7 …”

New directions in cancer and aging: State of the science and recommendations to improve the quality of evidence on the intersection of aging with cancer control

“…Cognitive and physical function impairments among older cancer survivors have been reported in clinic‐based and population‐based observational studies 15‐18 . Prevalence estimates among older cancer survivors vary widely because of heterogeneity in study methodologies, and, although functional impairment assessments exist, there are inconsistencies in the definitions of and methods for ascertainment of functional impairment 5,19‐21 . The causal roles of carcinogenesis and cancer treatments in altering ongoing physical and cognitive aging trajectories among older adults with cancer thus remain unclear 22 .…”

“…[15][16][17][18] Prevalence estimates among older cancer survivors vary widely because of heterogeneity in study methodologies, and, although functional impairment assessments exist, there are inconsistencies in the definitions of and methods for ascertainment of functional impairment. 5,[19][20][21] The causal roles of carcinogenesis and cancer treatments in altering ongoing physical and cognitive aging trajectories among older adults with cancer thus remain unclear. 22 However, the biologic rationale for accelerated physical and cognitive aging trajectories among older cancer survivors is strong.…”