Postmenopausal cancer survivors have greater declines in physical function than cancer-free control individuals, according to a study published in JAMA Oncology.
Researchers found that colorectal cancer survivors had significant declines in physical function in the first year after diagnosis, but declines slowed over time and were similar to those of control individuals at 5 years after diagnosis.
However, survivors of endometrial cancer, breast cancer, and lung cancer all had physical function levels lower than those of age-matched control individuals at 5 years after diagnosis.
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For this study, researchers analyzed 9203 postmenopausal cancer patients enrolled in the Women’s Health Initiative between 1993 and 1998. The patients had breast cancer (n=5989), colorectal cancer (n=1352), endometrial cancer (n=960), and lung cancer (n=902).
The mean age at diagnosis was 73 years. The cancer patients were matched by age and year of enrollment with up to 5 control individuals, for a total of 45,358 control individuals.
Study participants reported physical function using the RAND Short Form 36 scale. Scores on this scale range from 0 to 100, and higher scores indicate superior physical function.
For the most part, there was no significant difference in mean physical function at the index date between cancer patients and control individuals. However, patients newly diagnosed with lung cancer had reduced physical function (4 points lower for local lung cancer and 5 points lower for regional lung cancer vs control individuals).
In multivariable models, the rate of decline in physical function was approximately 1 point per year among cancer-free control individuals.
Before diagnosis, the rate of decline in physical function was significantly accelerated for patients with lung cancer or regional colorectal and endometrial cancer, compared with control individuals. For the other cancers, the pre-index declines in physical function did not differ between cancer patients and control individuals.
After a cancer diagnosis, patients experienced accelerated declines in physical function when compared with the pre-diagnosis rate among cancer patients and the post-index rate among control individuals.
Declines in physical function in the first year after cancer diagnosis were most severe in patients with regional cancer and those who received systemic therapy. For example, patients with local breast cancer had double the rate of decline in physical function as control individuals, but patients with regional breast cancer had nearly 4 times the rate of decline in physical function as control individuals.
“Importantly, we also found accelerated longer-term rates of decline that varied by cancer type, treatment, and stage,” the researchers wrote.
They noted that, at 5 years after diagnosis, colorectal cancer survivors had physical function similar to that of age-matched control individuals. For example, among patients with regional colorectal cancer, physical function declined 4.3 points per year in the first year after diagnosis, but this slowed to 1.4 points per year in subsequent years.
On the other hand, patients with breast, endometrial, and lung cancer all had significantly lower levels of physical function at the 5-year mark. For example, relative to matched control individuals, physical function scores were 2.0 points lower for survivors of local endometrial cancer and 7.1 points lower for survivors of regional endometrial cancer.
“This information can inform management decisions in postmenopausal women with common cancers,” the researchers concluded. “Future studies to define predictors of PF [physical function] trajectories could inform identification of populations for early interventions to mitigate PF decline.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Cespedes Feliciano EM, Vasan S, Luo J, et al. Long-term trajectories of physical function decline in women with and without cancer. JAMA Oncol. Published online January 19, 2023. doi:10.1001/jamaoncol.2022.6881
