Factors affecting recovery of functional status in older adults after cancer surgery

Abstract

Objectives: To explore factors influencing functional status over time after cancer surgery in adults aged 65 and older.

Design: Secondary data analysis of combined data subsets.

Setting: Five prospective, longitudinal oncology nurse-directed clinical studies conducted at three academic centers in the northwest and northeast United States.

Participants: Three hundred sixteen community-residing patients diagnosed with digestive system, thoracic, genitourinary, and gynecological cancers treated primarily with surgery.

Measurements: Functional status, defined as performance of current life roles, was measured using the Enforced Social Dependency Scale and the Medical Outcomes Study 36-item Short-Form Survey (using physical component summary measures) after surgery (baseline) and again at 3 and 6 months. Number of symptoms, measured using the Symptom Distress Scale, quantified the effect of each additional common cancer symptom on functional status.

Results: After controlling for cancer site and stage, comorbidities, symptoms, psychological status, treatment, and demographic variables, functional status was found to be significantly better at 3 and 6 months after surgery than at baseline. Factors associated with better functional status included higher income and better mental health. Factors associated with poorer average functional status were a greater number of symptoms and comorbidities. Persons reporting three or more symptoms experienced statistically significant and clinically meaningful poorer functional status than those without symptoms. Persons reporting three or more comorbidities were also found to have poorer functional status than those without comorbidities. No significant relationship existed between age and functional status in patients aged 65 and older.

Conclusion: Factors other than age affect recovery of functional status in older adults after cancer surgery.

Figure 1

Mean Medical Outcomes Study 36-item Short-Form Survey physical component summary score 50 ± 10 (possible range 2–76, but extreme scores are unlikely). Mean Enforced Social Dependency Scale score 50 ± 10 (possible range 20.2–67.5). Functional status score range 23.6 to 67.5. Time 1 = baseline data collection, Time 2 = data collection at 3 months, Time 3 = data collection at 6 months.