Multidimensional functional limitations in American cancer survivors: Characteristics and their effects on survival and healthcare utilization.

BACKGROUND

Cancer survivors often experience multidimensional functional limitations (FL) that can impact their overall health outcomes. This study primarily evaluated the associations of FL with all-cause and cancer-specific mortality, and secondarily with home care and emergency room use among US cancer survivors.

METHODS

Data from the 2004-2018 National Health Interview Survey (NHIS) were collected for this study. FL was defined as reporting difficulties in any of the 12 items across three dimensions: mobility, physical tasks and dexterity, and social and recreational engagement. The associations of FL with health outcomes were explored among 24,003 cancer survivors who were linked to the National Death Index (NDI) records through December 31, 2019. Multivariable Cox proportional hazard regression models, Fine and Gray regression models, and Logistic regression models were employed to estimate the associations between FL and all-cause mortality, cancer-specific mortality, home care, and emergency room use.

RESULTS

Cancer survivors reported significantly higher rates of FL compared to individuals without cancer across all FL items (all P < 0.001). FL was significantly associated with increased all-cause mortality (HR = 1.74, 95% CI = 1.59-1.91; P < 0.001), cancer-specific mortality (HR = 1.42, 95% CI = 1.27-1.58; P < 0.001), likelihood of requiring home care (OR = 4.05, 95% CI = 3.18-5.17; P < 0.001) and emergency room use (OR = 1.92, 95% CI = 1.75-2.11; P < 0.001). Similar results were found in the analyses for the three dimensions and the number of FL.

CONCLUSION

Three dimensions of FL were associated with increased mortality risk, home care, and emergency room use among cancer survivors. Targeted interventions to alleviate these limitations are essential for improving long-term outcomes.