Functional Decline in the Cancer Patient: A Review

Abstract

A decline in functional status, an individual’s ability to perform the normal activities required to maintain adequate health and meet basic needs, is part of normal ageing. Functional decline, however, appears to be accelerated in older patients with cancer. Such decline can occur as a result of a cancer itself, cancer treatment-related factors, or a combination of the two. The accelerated decline in function seen in older patients with cancer can be slowed, or even partly mitigated through routine assessments of functional status and timely interventions where appropriate. This is particularly important given the link between functional decline and impaired quality of life, increased mortality, comorbidity burden, and carer dependency. However, a routine assessment of and the use of interventions for functional decline do not typically feature in the long-term care of cancer survivors. This review outlines the link between cancer and subsequent functional decline, as well as potential underlying mechanisms, the tools that can be used to assess functional status, and strategies for its prevention and management in older patients with cancer.

Change in four measures of physical function among older adults during lung cancer treatment: A mixed methods cohort study

“…Non-small cell lung cancer (NSCLC) is the leading cause of cancerrelated death in the US with 68% of cases diagnosed in adults age ≥ 65 [1]. Older adults who receive systemic therapy are at risk for impaired physical function from both the cancer and the treatment [2][3][4][5][6][7], and functional decline is associated with worse quality of life and survival [2,8,9]. In a study of older adults, >70% of those with cancer reported that they would not select a treatment that caused severe functional impairment, even if it improved survival [10].…”

Association between Quality of Life and Physical Functioning in a Gardening Intervention for Cancer Survivors

“…While rates are higher during treatment and for patients with metastatic disease, a recent meta-analysis reported a pain prevalence rate of 39.3% among post-treatment cancer survivors [ 37 ]. Pain is a well-known predictor of functional impairment and decline among older cancer survivors [ 38 , 39 , 40 ], so it is not surprising that it was associated with worse physical function during the study. This study did not assess whether pain management changed during the study, but some studies have reported reduced outpatient healthcare visits during the early stages of the pandemic [ 41 ].…”

“…In fact, depression in cancer survivors appears to be underdiagnosed and untreated [ 49 ]. Fatigue and depression also are well-known predictors of physical function decline among older cancer survivors [ 38 , 39 , 40 ]. There have been fewer studies examining the association between sleep disturbance and impaired physical functioning among cancer survivors, but evidence to date suggests that sleep disturbance is associated with problems with instrumental activities of daily living (IADLs) or poor self-reported physical function [ 50 , 51 ].…”

Exploration of Aging-Care Parameters to Predict Mortality of Patients Aged 80-Years and Above with Community-Acquired Pneumonia

“…While, the management strategies of functional decline largely overlap with those targeting frailty, given that frailty is effectively a marker for the potential for functional decline. 56 So, reversing the frailty may play an important role in improving functional status. In addition, early detection, physical activity, and dietary interventions should also be helpful.…”