Journal of geriatric oncology · 2025
Risk of early functional decline and its association with overall survival among older adults with newly diagnosed gastrointestinal malignancies undergoing systemic therapy.
СтатьяНазвание и аннотация: Перевод в очереди
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Giri Smith, Griffin Russell, Newbrough Mark, Williams Grant R, Richman Joshua, Shrestha Sadeep, Bhatia Smita
Аннотация
INTRODUCTION: Older adults with cancer undergoing systemic therapy are at the greatest risk of experiencing adverse effects including functional decline. We aimed to understand the risk of functional decline at three months after starting systemic therapy among older adults with gastrointestinal (GI) cancer undergoing systemic therapy.
MATERIALS AND METHODS: Using data from a prospective cohort study, we identified older adults ≥60y with newly diagnosed GI cancer initiating systemic therapy at our institution, who underwent functional status evaluation at baseline and at three months follow up. Functional status was measured by self-report using Older American Resources and Services (OARS) activities of daily living questionnaire. Functional decline was defined as a 1-point decline in activities of daily living (ADL) or independent activities of daily living (IADL). We used Cox regression models to study the association between functional decline and all-cause mortality adjusting for relevant confounders.
RESULTS: We identified 306 older adults with a median age at study participation of 68 years. Overall, 31.4% experienced functional decline. Functional decline was associated with significantly greater risk of all-cause mortality (adjusted hazard ratio 1.45; 95% confidence interval 1.04-2.01; p value <0.001) after adjusting for age, sex, race/ethnicity, cancer type, cancer stage, baseline frailty, baseline functional status, and regimen intensity. Similar results were seen when analyzing separately for ADL and IADL decline.
DISCUSSION: One in three older adults (≥60y) with GI cancers initiating systemic therapy experience functional decline at 3 months follow-up. Early functional decline is independently associated with a 45% increased risk of all-cause mortality.
MATERIALS AND METHODS: Using data from a prospective cohort study, we identified older adults ≥60y with newly diagnosed GI cancer initiating systemic therapy at our institution, who underwent functional status evaluation at baseline and at three months follow up. Functional status was measured by self-report using Older American Resources and Services (OARS) activities of daily living questionnaire. Functional decline was defined as a 1-point decline in activities of daily living (ADL) or independent activities of daily living (IADL). We used Cox regression models to study the association between functional decline and all-cause mortality adjusting for relevant confounders.
RESULTS: We identified 306 older adults with a median age at study participation of 68 years. Overall, 31.4% experienced functional decline. Functional decline was associated with significantly greater risk of all-cause mortality (adjusted hazard ratio 1.45; 95% confidence interval 1.04-2.01; p value <0.001) after adjusting for age, sex, race/ethnicity, cancer type, cancer stage, baseline frailty, baseline functional status, and regimen intensity. Similar results were seen when analyzing separately for ADL and IADL decline.
DISCUSSION: One in three older adults (≥60y) with GI cancers initiating systemic therapy experience functional decline at 3 months follow-up. Early functional decline is independently associated with a 45% increased risk of all-cause mortality.