Functional Decline in the Cancer Patient: A Review

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2022 Mar 25

PMID 35326520

Authors

Jaidyn Muhandiramge

Suzanne G Orchard

Erica T Warner

Gijsberta J van Londen

John R Zalcberg

Affiliations

Soon will be listed here.

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.

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References

Reuben D, Siu A . An objective measure of physical function of elderly outpatients. The Physical Performance Test. J Am Geriatr Soc. 1990; 38(10):1105-12. DOI: 10.1111/j.1532-5415.1990.tb01373.x. View

Bylow K, Hemmerich J, Mohile S, Stadler W, Sajid S, Dale W . Obese frailty, physical performance deficits, and falls in older men with biochemical recurrence of prostate cancer on androgen deprivation therapy: a case-control study. Urology. 2011; 77(4):934-40. PMC: 3074039. DOI: 10.1016/j.urology.2010.11.024. View

Neo J, Fettes L, Gao W, Higginson I, Maddocks M . Disability in activities of daily living among adults with cancer: A systematic review and meta-analysis. Cancer Treat Rev. 2017; 61:94-106. DOI: 10.1016/j.ctrv.2017.10.006. View

Nipp R, Ruddy M, Fuh C, Zangardi M, Chio C, Kim E . Pilot Randomized Trial of a Pharmacy Intervention for Older Adults with Cancer. Oncologist. 2018; 24(2):211-218. PMC: 6369952. DOI: 10.1634/theoncologist.2018-0408. View

Amidei C, Kushner D . Clinical implications of motor deficits related to brain tumors. Neurooncol Pract. 2019; 2(4):179-184. PMC: 6664611. DOI: 10.1093/nop/npv017. View

Nightingale G, Battisti N, Loh K, Puts M, Kenis C, Goldberg A . Perspectives on functional status in older adults with cancer: An interprofessional report from the International Society of Geriatric Oncology (SIOG) nursing and allied health interest group and young SIOG. J Geriatr Oncol. 2020; 12(4):658-665. PMC: 8102651. DOI: 10.1016/j.jgo.2020.10.018. View

van den Beuken-van Everdingen M, Hochstenbach L, Joosten E, Tjan-Heijnen V, Janssen D . Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2016; 51(6):1070-1090.e9. DOI: 10.1016/j.jpainsymman.2015.12.340. View

Muhandiramge J, Orchard S, Haydon A, Zalcberg J . The acceleration of ageing in older patients with cancer. J Geriatr Oncol. 2020; 12(3):343-351. DOI: 10.1016/j.jgo.2020.09.010. View

Gloth 3rd F, Scheve A, Shah S, Ashton R, McKinney R . The Frail Elderly Functional Assessment questionnaire: its responsiveness and validity in alternative settings. Arch Phys Med Rehabil. 1999; 80(12):1572-6. DOI: 10.1016/s0003-9993(99)90332-5. View

10.

La Carpia D, Liperoti R, Guglielmo M, Di Capua B, Devizzi L, Matteucci P . Cognitive decline in older long-term survivors from Non-Hodgkin Lymphoma: a multicenter cross-sectional study. J Geriatr Oncol. 2020; 11(5):790-795. DOI: 10.1016/j.jgo.2020.01.007. View

11.

Celis-Morales C, Welsh P, Lyall D, Steell L, Petermann F, Anderson J . Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants. BMJ. 2018; 361:k1651. PMC: 5939721. DOI: 10.1136/bmj.k1651. View

12.

Beaudart C, Buckinx F, Rabenda V, Gillain S, Cavalier E, Slomian J . The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2014; 99(11):4336-45. DOI: 10.1210/jc.2014-1742. View

13.

Oken M, Creech R, Tormey D, Horton J, Davis T, McFadden E . Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5(6):649-55. View

14.

Ramos J, Dalleck L, Tjonna A, Beetham K, Coombes J . The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sports Med. 2015; 45(5):679-92. DOI: 10.1007/s40279-015-0321-z. View

15.

MAHONEY F, BARTHEL D . FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14:61-5. View

16.

Chen C, Ho-Chang , Huang Y, Hung T . Hand-grip strength is a simple and effective outcome predictor in esophageal cancer following esophagectomy with reconstruction: a prospective study. J Cardiothorac Surg. 2011; 6:98. PMC: 3170319. DOI: 10.1186/1749-8090-6-98. View

17.

Peron E, Gray S, Hanlon J . Medication use and functional status decline in older adults: a narrative review. Am J Geriatr Pharmacother. 2011; 9(6):378-91. PMC: 3398458. DOI: 10.1016/j.amjopharm.2011.10.002. View

18.

De Ruysscher D, Niedermann G, Burnet N, Siva S, Lee A, Hegi-Johnson F . Radiotherapy toxicity. Nat Rev Dis Primers. 2019; 5(1):13. DOI: 10.1038/s41572-019-0064-5. View

19.

Haj Mohammad N, De Rooij S, Hulshof M, Ruurda J, Wijnhoven B, Erdkamp F . Activities of daily living and quality of life during treatment with neoadjuvant chemoradiotherapy and after surgery in patients with esophageal cancer. J Surg Oncol. 2016; 114(6):684-690. DOI: 10.1002/jso.24378. View

20.

van der Meij B, Langius J, Spreeuwenberg M, Slootmaker S, Paul M, Smit E . Oral nutritional supplements containing n-3 polyunsaturated fatty acids affect quality of life and functional status in lung cancer patients during multimodality treatment: an RCT. Eur J Clin Nutr. 2012; 66(3):399-404. PMC: 3303137. DOI: 10.1038/ejcn.2011.214. View