Functional decline in older patients with cancer receiving chemotherapy: A multicenter prospective study.
OBJECTIVE
This study aims to evaluate the evolution of functional status (FS) 2 to 3months after initiation of chemotherapy, to identify factors associated with functional decline during chemotherapy treatment and to investigate the prognostic value of functional decline for overall survival (OS).


METHODS
Patients ≥70years with a malignant tumor were included when chemotherapy was initiated. All patients underwent a geriatric assessment (GA) including FS measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). FS of patients was followed by repeating ADL and IADL to identify functional decline.


RESULTS
From 10/2009 until 07/2011, 439 patients were included. At follow-up, ADL and IADL data were available for 387 patients. Functional decline in ADL and IADL was observed in 19.9% and 41.3% of the patients respectively. In multivariable logistic regression analysis, baseline factors associated with decline in ADL are abnormal nutritional status (OR:2.02) and IADL dependency (OR:1.76). Oncological setting (disease progression/relapse vs new diagnosis) (OR:0.59) is the only determinant of decline in IADL. Functional decline in ADL is strongly prognostic for OS (logrank p-value<.0001; Wilcoxon p-value<.0001) with HR 2.34 and functional decline in IADL is also prognostic for OS but less prominent with HR 1.25.


CONCLUSIONS
Functional decline occurs in about a third of older patients with cancer receiving chemotherapy and is associated with GA components. It strongly predicts survival, the most prominent for ADL. This knowledge can be used to identify older persons with cancer receiving chemotherapy eligible for interventions to prevent functional decline.
Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium. Electronic address: cindy.kenis@uzleuven.be.
Cindy
C
Kenis
Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: lore.decoster@uzbrussel.be.
Lore
L
Decoster
Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium. Electronic address: julie_bastin@hotmail.com.
Julie
J
Bastin
Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium. Electronic address: hannelore.bode@gmail.com.
Hannelore
H
Bode
Frailty in Ageing (FRIA) Research Group & Gerontology Department, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: katrien.vanpuyvelde@asz.be.
Katrien
K
Van Puyvelde
Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: jacques.degreve@uzbrussel.be.
Jacques
J
De Grève
Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: godelieve.conings@uzbrussel.be.
Godelieve
G
Conings
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium. Electronic address: katleen.fagard@uzleuven.be.
Katleen
K
Fagard
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Clinical and Experimental Medicine, KU Leuven, Belgium. Electronic address: johan.flamaing@uzleuven.be.
Johan
J
Flamaing
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Belgium. Electronic address: koen.milisen@kuleuven.be.
Koen
K
Milisen
Consultant in Statistics, Beernem, Belgium. Electronic address: jeanpierre.lobelle@gmail.com.
Jean-Pierre
JP
Lobelle
Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Belgium. Electronic address: hans.wildiers@uzleuven.be.
Hans
H
Wildiers
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000523:psychology; D009752:Nutritional Status; D011446:Prospective Studies; D012044:Regression Analysis
D000970:Antineoplastic Agents
Cancer; Functional decline; Functional status; Geriatric assessment; Older person; Survival