Functional status decline in older patients with breast and colorectal cancer after cancer treatment: A prospective cohort study.
OBJECTIVE
The aim of the present study was to disentangle the impact of age and that of cancer diagnosis and treatment on functional status (FS) decline in older patients with cancer.


METHODS
Patients with breast and colorectal cancer aged 50-69years and aged ≥70years who had undergone surgery, and older patients without cancer aged ≥70years were included. FS was assessed at baseline and after 12months follow-up, using the Katz index for activities of daily living (ADL) and the Lawton scale for instrumental activities of daily living (IADL). FS decline was defined as ≥1 point decrease on the ADL or IADL scale from baseline to 12months follow-up.


RESULTS
In total, 179 older patients with cancer (≥ 70years), 341 younger patients with cancer (50-69years) and 317 older patients without cancer (≥ 70years) were included. FS decline was found in 43.6%, 24.6% and 28.1% of the groups, respectively. FS decline was significantly worse in older compared to younger patients with cancer receiving no chemotherapy (44.5% versus 17.6%, p<0.001), but not for those who did receive chemotherapy (39.4% versus 30.8%, p=0.33). Among the patients with cancer, FS decline was significantly associated with older age (OR 2.63), female sex (OR 3.72), colorectal cancer (OR 2.81), polypharmacy (OR 2.10) and, inversely, with baseline ADL dependency (OR 0.44).


CONCLUSIONS
Cancer treatment, and older age are important predictors of FS decline. The relation of baseline ADL dependency and chemotherapy with FS decline suggest that the fittest of the older patients with cancer were selected for chemotherapy.
Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands. Electronic address: d.l.van.abbema@hva.nl.
Doris
D
van Abbema
Department of Internal Medicine, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen-Geleen, The Netherlands.
Arnée
A
van Vuuren
Department of Internal Medicine, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen-Geleen, The Netherlands.
Franchette
F
van den Berkmortel
Department of Family Medicine, Maastricht University, Peter Debyelaan 1, 6229 HX, Maastricht, The Netherlands; Department of General Practice, KU Leuven, Kapucijnenvoer 33, PB 7001 3000 Leuven, Belgium.
Marjan
M
van den Akker
Department of General Practice, KU Leuven, Kapucijnenvoer 33, PB 7001 3000 Leuven, Belgium. Electronic address: l.deckx@uq.edu.au.
Laura
L
Deckx
Department of Family Medicine, Maastricht University, Peter Debyelaan 1, 6229 HX, Maastricht, The Netherlands; Department of General Practice, KU Leuven, Kapucijnenvoer 33, PB 7001 3000 Leuven, Belgium.
Frank
F
Buntinx
Department of Internal Medicine, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen-Geleen, The Netherlands.
Roel
R
van Kampen
Department of Internal Medicine, Máxima Medical Center, De Run 4600, 5504, DB, Veldhoven, The Netherlands.
Els
E
Lambooij
Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
Maaike
M
de Boer
Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
Judith
J
de Vos-Geelen
Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands. Electronic address: vcg.tjan.heijnen@mumc.nl.
Vivianne C
VC
Tjan-Heijnen
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000628:therapy*; D016022:Case-Control Studies; D060825:Cognitive Dysfunction / Q000209:etiology; D015179:Colorectal Neoplasms / Q000628:therapy*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales
D000970:Antineoplastic Agents
Activities of daily living; Breast cancer; Chemotherapy; Colorectal cancer; Elderly; Functional status; Instrumental activities of daily living; Older patients