Modifiable factors affecting older patients' quality of life and physical function during cancer treatment

Lene Kirkhus; Magnus Harneshaug; Jūratė Šaltytė Benth; Bjørn Henning Grønberg; Siri Rostoft; Sverre Bergh; Marianne J Hjermstad; Geir Selbæk; Torgeir Bruun Wyller; Øyvind Kirkevold; Tom Borza; Ingvild Saltvedt; Marit S Jordhøy

doi:10.1016/j.jgo.2019.08.001

Modifiable factors affecting older patients' quality of life and physical function during cancer treatment

J Geriatr Oncol. 2019 Nov;10(6):904-912. doi: 10.1016/j.jgo.2019.08.001. Epub 2019 Aug 21.

Authors

Affiliations

¹ The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 4956, Nydalen, 0424 Oslo, Norway. Electronic address: lenkir@ous-hf.no.
² The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 4956, Nydalen, 0424 Oslo, Norway.
³ The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, 2313 Ottestad, Norway; Health Services Research Unit, Akershus University Hospital, P.O. box 1000, 1478 Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, P.O.Box 1171, 0318 Blindern, Norway.
⁴ Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. box 8905, 7491 Trondheim, Norway; The Cancer Clinic, St. Olav Hospital, Trondheim University Hospital, P.O. box 3250 Sluppen, 7006 Trondheim, Norway.
⁵ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 4956, Nydalen, 0424 Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, P.O box 4956, Nydalen, 0424 Oslo, Norway; Regional Advisory Unit for Palliative Care, Dept. of Oncology, Oslo University Hospital, P.O. box 4956, Nydalen, 0424 Oslo, Norway(7).
⁶ The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, 2313 Ottestad, Norway; Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, P.O. box 2136, 3103 Tønsberg, Norway.
⁷ Regional Advisory Unit for Palliative Care, Dept. of Oncology, Oslo University Hospital, P.O. box 4956, Nydalen, 0424 Oslo, Norway(7); European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital / Institute of Clinical Medicine, University of Oslo, P.O box 4956, Nydalen, 0424, Oslo, Norway.
⁸ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 4956, Nydalen, 0424 Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, P.O box 4956, Nydalen, 0424 Oslo, Norway; Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, P.O. box 2136, 3103 Tønsberg, Norway.
⁹ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 4956, Nydalen, 0424 Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, P.O box 4956, Nydalen, 0424 Oslo, Norway.
¹⁰ The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, 2313 Ottestad, Norway; Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, P.O. box 2136, 3103 Tønsberg, Norway; Faculty of Health, Care and Nursing, NTNU Gjøvik, Teknologivegen 22, 2815 Gjøvik, Norway.
¹¹ The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, 2313 Ottestad, Norway.
¹² Dep of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, P.O. box 8905, 7491 Trondheim, Norway; Department of Geriatric Medicine, St. Olav Hospital, Trondheim University Hospital, P.O. box 3250 Sluppen, 7006 Trondheim, Norway.
¹³ The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 4956, Nydalen, 0424 Oslo, Norway; The Cancer Unit, Innlandet Hospital Trust, Hamar Hospital, Skolegata 32, 2326 Hamar, Norway.

PMID: 31444088
DOI: 10.1016/j.jgo.2019.08.001

Abstract

Background: Maintaining physical function and quality of life (QoL) are prioritized outcomes among older adults. We aimed to identify potentially modifiable factors affecting older patients' physical function and QoL during cancer treatment.

Methods: Prospective, multicenter study of 307 patients with cancer ≥70 years, referred for systemic treatment. Pre-treatment, a modified geriatric assessment (mGA) was performed, including registration of comorbidities, medications, nutritional status, cognitive function, depressive symptoms (Geriatric Depression Scale-15 [GDS]), and mobility (Timed Up and Go [TUG]). Patient-reported physical function (PF)-, global QoL-, and symptom scores were assessed at baseline, two, four, and six months by the EORTC Quality of Life Core Questionnaire-C30. The impact of mGA components and symptoms on patients' PF and global QoL scores during six months was investigated by linear mixed models. To identify groups following distinct PF trajectories, a growth mixture model was estimated.

Results: 288 patients were eligible, mean age was 76.9 years, 68% received palliative treatment. Higher GDS-scores and poorer TUG were independently associated with an overall level of poorer PF and global QoL throughout follow-up, as were more pain, dyspnea, and appetite loss, and sleep disturbance. Three groups with distinct PF trajectories were identified: a poor group exhibiting a non-linear statistically (p < .001) and clinically significant decline (≥10 points), an intermediate group with a statistically (p = .003), but not clinically significant linear decline, and a good group with a stable trajectory. Higher GDS-scores and poorer TUG, more pre-treatment pain and dyspnea were associated with higher odds of belonging to the poor compared to the good PF group.

Conclusion: Depressive symptoms, reduced mobility, and more physical symptoms increased the risk of decrements in older patients' PF and global QoL scores during cancer treatment, and represent potential targets for interventions aiming at improving these outcomes.

Trial registration: ClinicalTrials.gov NCT01742442.

Keywords: Geriatric assessment; Geriatric oncology; Physical function; Quality of life.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living*
Aged
Aged, 80 and over
Female
Frailty / diagnosis
Frailty / epidemiology
Geriatric Assessment / methods*
Health Status Indicators
Humans
Male
Malnutrition / diagnosis
Malnutrition / epidemiology
Neoplasms / epidemiology
Neoplasms / psychology
Neoplasms / therapy*
Physical Functional Performance*
Prospective Studies
Quality of Life*
Time Factors

Associated data

ClinicalTrials.gov/NCT01742442