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

Wong, Melisa L.; Paul, Steven M.; Mastick, Judy; Ritchie, Christine S.; Steinman, Michael A.; Walter, Louise C.; Miaskowski, Christine

doi:10.1016/j.jpainsymman.2018.08.006

Cited by 17 publications

(13 citation statements)

References 71 publications

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“…Although previous cross-sectional studies showed higher physical function impairment in lung cancer patients vs other cancers, 30 recent prospective studies also suggested findings similar to our study such that function decline or trajectory are not associated with the type of cancer diagnosis but may be associated with type of cancer treatments and new cancer diagnosis. 31,32 Future studies should investigate whether the association between symptoms burden and physical function is moderated by cancer type.…”

Section: Discussionmentioning

confidence: 99%

Association Between Symptom Burden and Physical Function in Older Patients with Cancer

Pandya

Magnuson

Flannery

et al. 2019

J American Geriatrics Society

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OBJECTIVES To evaluate the independent association between symptom burden and physical function impairment in older adults with cancer. DESIGN Cross‐sectional. SETTING Two university‐based geriatric oncology clinics. PARTICIPANTS Patients with cancer aged 65 years or older who underwent evaluation with geriatric assessment (GA). MEASUREMENTS Symptom burden was measured as a summary score of severity ratings (range = 0‐10) of 10 commonly reported symptoms using a Clinical Symptom Inventory (CSI). Functional impairment was defined as the presence of one or more impairments of instrumental activities of daily living (IADLs), any significant physical activity limitation on the Medical Outcomes Survey (MOS), one or more recent falls in the previous 6 months, or a Short Physical Performance Battery (SPPB) score of 9 or less. Multivariate analysis evaluated the association between symptom burden and physical function impairment, adjusting for other clinical and sociodemographic variables. RESULTS From 2011 to 2015, 359 patients with cancer and a median age of 81 years (range = 65‐95 y) consented. The mean CSI score was 23.2 ± 20.5 with an observed range of 0 to 90. Patients in the highest quartile of symptom burden (N = 91; CSI score 52 ± 13) had a higher prevalence of IADL impairment (91% vs 51%), physical activity limitation (93% vs 65%), falls (55% vs 21%), and SPPB score of 9 or less (92% vs 69%) (all P values <.01) when compared with those in the bottom quartile (N = 81; CSI score: 2 ± 2). With each unit increase in CSI score, the odds of having IADL impairment, physical activity limitations, falls, and SPPB scores of 9 or less increased by 4.8%, 4.4%, 2.9%, and 2.5%, respectively (P < .05 for all results). CONCLUSIONS In older patients with cancer, higher symptom burden is associated with functional impairment. Future studies are warranted to evaluate if improved symptom management can improve function in older cancer patients. J Am Geriatr Soc 67:998–1004, 2019.

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Section: Discussionmentioning

confidence: 99%

Association Between Symptom Burden and Physical Function in Older Patients with Cancer

Pandya

Magnuson

Flannery

et al. 2019

J American Geriatrics Society

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“…Older adults with cancer are at increased risk for treatment toxicity and functional impairment, [1][2][3][4] resulting in increased healthcare use and mortality. [5][6][7][8][9][10] Maintaining functional status (FS) during cancer treatment is critically important to patients. More than 70% of older patients with cancer report that they would not choose a treatment that results in functional impairment, even if it improves survival.…”

Section: Introductionmentioning

confidence: 99%

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

Loh

Lam

Webber

et al. 2021

Journal of the National Comprehensive Cancer Network

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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).

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“…For this analysis, we selected two of the most common symptomatic AEs in CALGB 9730, fatigue and neuropathy, based on their prevalence in the trial [10], clinical relevance, and impact on QOL in older adults [15][16][17][18]. Fatigue is one of the most common and distressing symptoms among older patients with NSCLC and is associated with functional decline with chemotherapy [17,19]. Neuropathy can interfere with daily activities and is associated with increased fall risk and lower QOL [16,18,20,21].…”

Section: Discussionmentioning

confidence: 99%

Expanding Beyond Maximum Grade: Chemotherapy Toxicity over Time by Age and Performance Status in Advanced Non-Small Cell Lung Cancer in CALGB 9730 (Alliance A151729)

et al. 2020

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Background. Prior comparisons of chemotherapy adverse events (AEs) by age and performance status (PS) are limited by the traditional maximum grade approach, which ignores low-grade AEs and longitudinal changes. Materials and Methods. To compare fatigue and neuropathy longitudinally by age (<65, ≥65 years) and PS (0-1, 2), we analyzed data from a large phase III trial of carboplatin and paclitaxel versus paclitaxel for advanced non-small cell lung cancer (CALGB 9730, n = 529). We performed multivariable (a) linear mixed models to estimate mean AE grade over time, (b) linear regression to estimate area under the curve (AUC), and (c) proportional hazards models to estimate the hazard ratio of developing grade ≥2 AE, as well as traditional maximum grade analyses. Results. Older patients had on average a 0.17-point (95% confidence interval [CI], 0.00-0.34; p = .049) higher mean fatigue grade longitudinally compared with younger patients. PS 2 was associated with earlier development of grade ≥2 fatigue (hazard ratio [HR], 1.56; 95% CI, 1.07-2.27; p = .02). For neuropathy, older age was associated with earlier development of grade ≥2 neuropathy (HR, 1.41; 95% CI, 1.00-1.97; p = .049). Patients with PS 2 had a 1.30 point lower neuropathy AUC (95% CI, −2.36 to −0.25; p = .02) compared with PS 0-1. In contrast, maximum grade analyses only detected a higher percentage of older adults with grade ≥3 fatigue and neuropathy at some point during treatment. Conclusion. Our comparison of complementary but distinct aspects of chemotherapy toxicity identified important longitudinal differences in fatigue and neuropathy by age and PS that are missed by the traditional maximum grade approach. Clinical trial identification number. NCT00003117 (CALGB 9730

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

Cited by 17 publications

References 71 publications

Association Between Symptom Burden and Physical Function in Older Patients with Cancer

Association Between Symptom Burden and Physical Function in Older Patients with Cancer

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

Expanding Beyond Maximum Grade: Chemotherapy Toxicity over Time by Age and Performance Status in Advanced Non-Small Cell Lung Cancer in CALGB 9730 (Alliance A151729)

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