title: Functional status declines among cancer survivors: trajectory and contributing factors.
abstract: OBJECTIVE
  This study aimed to quantify functional status (FS) trajectories pre- and post-diagnosis of cancer, FS trajectories among cancer-free individuals, and factors affecting FS.
  
  
  METHODS
  Self-reported FS, scored from 0 (worst) to 100 (best), of Atherosclerosis Risk in Communities (ARIC) Study cohort participants diagnosed with incident cancer (lung (N=303), breast (N=374), prostate (N=529), colorectal (N=228)), and cancer-free participants (N=11,155) over 15 years was examined. FS was evaluated in two ways: 1) until death or follow-up year 15 (Model 1) and 2) same as survivorship model except that a FS value of zero was used for assessments after death to follow-up year 15 (Model 2). Mean FS at discrete time points were used to generate FS trajectories. Differences in repeated measures of FS were assessed using linear growth models.
  
  
  RESULTS
  Within one year after diagnosis, FS scores declined compared to the cancer-free group, except for prostate cancer. FS continued to decline beyond one year after lung or colorectal cancer diagnosis. FS was lower in all cancer groups, except prostate, compared to the cancer-free group (Model 1: lung -4.76, breast -2.28, colorectal -2.55; Model 2: lung -2.36, breast -2.46, colorectal -2.31). Predictors of decreased FS score independent of cancer diagnosis included low education, comorbidities, obesity, smoking, lack of health insurance, and age.
  
  
  CONCLUSIONS
  FS in all incident cancer groups declined during the first year post-diagnosis, which could be due to intensive treatments. Targeting factors related to FS declines could improve health outcomes for patients with cancer.
authors: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States. Electronic address: jessica.petrick@unc.edu.
authors: Jessica L
authors: JL
authors: Petrick
authors: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States.
authors: Bryce B
authors: BB
authors: Reeve
authors: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States.
authors: Anna M
authors: AM
authors: Kucharska-Newton
authors: Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States.
authors: Randi E
authors: RE
authors: Foraker
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
authors: Elizabeth A
authors: EA
authors: Platz
authors: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States.
authors: Sally C
authors: SC
authors: Stearns
authors: Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States.
authors: Xuesong
authors: X
authors: Han
authors: The University of Mississippi Medical Center, Jackson, MS, United States.
authors: B Gwen
authors: BG
authors: Windham
authors: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States.
authors: Debra E
authors: DE
authors: Irwin
mesh_terms: D000203:Activities of Daily Living; D001943:Breast Neoplasms / Q000453:epidemiology*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: Cancer survivorship; Functional status; Health-related quality of life; Longitudinal studies