Association Between Symptom Burden and Physical Function in Older Patients with Cancer

Pandya, Chintan; Magnuson, Allison; Flannery, Marie; Zittel, Jason; Duberstein, Paul R.; Loh, Kah Poh; Ramsdale, Erika; Gilmore, Nikesha; Dale, William; Mohile, Supriya G.

doi:10.1111/jgs.15864

Cited by 47 publications

(43 citation statements)

References 44 publications

(85 reference statements)

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“…Our finding that patients with more comorbidity spent less time in physical activity and had lower levels of hand grip strength and lower body muscle function is in line with the results of previous studies. More comorbidity and a higher tumor stage might be accompanied by a higher symptom burden of these patients, which may be associated with functional impairment and lower levels of physical activity and fitness [45]. Future exercise interventions should be optimally tailored to patients with comorbidities and a higher tumor stage [46].…”

Section: Discussionmentioning

confidence: 99%

Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer

et al. 2019

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Introduction: Objective measurements of levels of physical activity and fitness in patients with head and neck cancer (HNC) are lacking. Furthermore, demographic, clinical and lifestyle-related correlates of low levels of physical activity and fitness in patients with HNC are unknown. This study aims to investigate the levels of accelerometer that assessed physical activity and fitness in patients with HNC and to identify their demographical, clinical and lifestyle-related correlates. Methods: Two hundred and fifty-four patients who were recently diagnosed with HNC and participated in the NETherlands QUality of life and Biomedical cohort studies In head and neck Cancer (NET-QUBIC) study were included. Physical activity (accelerometer), cardiorespiratory fitness (Chester Step Test), hand grip strength (hand dynamometer) and lower body muscle function (30-second chair-stand test) were assessed. Multivariable linear regression analyses with a stepwise forward selection procedure were used. Results: Patients spent 229 min/d in physical activity of which 18 min/d in moderate-to-vigorous physical activity. The mean predicted VO 2 max was 27.9 ml/kg/min, the mean hand grip strength was 38.1 kg and the mean number of standings was 14.3. Patients with lower educational level, more comorbidity and higher tumor stage spent significantly less time in physical activity. Older patients, females and patients with a higher tumor stage had significantly lower cardiorespiratory fitness levels. Older patients, females, patients with more comorbidity, patients with normal weight and patients who have never smoked had significantly lower hand grip strength. Older patients, patients with lower educational level, smokers and patients with more comorbidity had a significantly lower function of lower body muscle. Conclusions: Pre-treatment levels of physical activity, cardiorespiratory fitness and lower body muscle function are low in patients with HNC. Based on this study, exercise programs targeted and tailored to patients with low levels of physical activity and fitness can be developed.

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Section: Discussionmentioning

confidence: 99%

Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer

et al. 2019

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“…cardiovascular disease [CVD]) can impact an older survivor's symptom burden and overall health-related quality of life (HRQOL) [4][5][6]. Pain, fatigue, and physical function limitations are some of the most commonly impaired domains of HRQOL reported by older cancer survivors [7][8][9][10][11]. Understanding how multimorbidity may influence older cancer survivors' outcomes following diagnosis is an important step in identifying and tailoring symptom management for survivors.…”

Section: Introductionmentioning

confidence: 99%

Examination of individual and multiple comorbid conditions and health-related quality of life in older cancer survivors

Siembida

Smith

Potosky³

et al. 2021

Qual Life Res

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Purpose Older cancer survivors (≥ 65 years at diagnosis) are at high-risk for multimorbidity (2 + comorbid conditions). However, few studies have utilized a generalizable sample of older cancer survivors to understand how individual comorbid conditions, as opposed to total comorbidity burden, are associated with health-related quality of life (HRQOL). We examined associations between HRQOL outcomes (pain, fatigue, physical function), individual comorbidities (cardiovascular disease [CVD], lung disease, diabetes, arthritis) and total comorbidity (cancer-only, cancer + 1 condition, cancer + 2 or more conditions). Methods Utilizing a population-based sample of 2019 older cancer survivors, we tested associations between comorbid conditions and the HRQOL outcomes using generalized linear models. HRQOL domains were assessed using Patient-Reported Outcome Measurement Information System ® (PROMIS ® ) measures. Comorbidity was assessed via self-report. Results Cancer survivors with lung disease reported significantly worse physical functioning (β = − 4.96, p < 0.001), survivors with arthritis reported significantly higher pain (β = 4.37, p < 0.001), and survivors with CVD reported significantly higher fatigue (β = 3.45, p < 0.001) compared to survivors without each condition. Having cancer + 1 condition was not as strongly associated with all outcomes as when individual conditions were tested (e.g. pain: β = 3.09, p < 0.001). Having 2+ comorbidities had a stronger association with all outcomes (e.g. physical function: β = − 7.51, p < 0.001) than examining conditions individually. Conclusions Knowing the specific comorbid condition profile of an older cancer survivor provides insight into specific HRQOL outcomes that may be impaired in cancer survivorship, but understanding total comorbidity burden, regardless of the specific conditions, sheds light on survivors at-risk for multiple impairments in HRQOL. This information, taken together, can inform risk-stratified survivorship care.

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“…This was secondary analysis of a nationwide geriatric assessment cluster-randomized controlled trial (URCC 13070, NCT02107443; Principal Investigator: Mohile). We have previously reported the details of the study [7,[23][24][25]. The primary study evaluated whether providing geriatric assessment (GA) and GA-driven recommendations to patients, their caregivers, and their oncologists increased discussions about age-related concerns and improved patient and caregiver satisfaction.…”

Section: Study Design Participants and Settingmentioning

confidence: 99%

Caregiver–Oncologist Prognostic Concordance, Caregiver Mastery, and Caregiver Psychological Health and Quality of Life

et al. 2021

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Background Caregivers of adults with cancer often report a different understanding of the patient's prognosis than the oncologist. We examine the associations of caregiver–oncologist prognostic concordance with caregiver depressive symptoms, distress, and quality of life (QoL). We also explore whether these relationships differed by caregiver environment mastery, an individual's sense of control, and effectiveness in managing life situations. Materials and Methods We used data from a national geriatric assessment cluster‐randomized trial (URCC 13070) that recruited patients aged 70 years and older with incurable cancer considering any line of cancer treatment at community oncology practices, their caregivers, and their oncologists. At enrollment, caregivers and oncologists estimated the patient's prognosis (0–6 months, 7–12 months, 1–2 years, 2–5 years, and >5 years; identical responses were concordant). Caregivers completed the Ryff's environmental mastery at enrollment. At 4–6 weeks, caregivers completed the Patient Health Questionnaire‐2 (depressive symptoms), distress thermometer, and 12‐Item Short‐Form Health Survey (quality of life [QoL]). We used generalized estimating equations in models adjusted for covariates. We then assessed the moderation effect of caregiver mastery. Results Of 411 caregiver–oncologist dyads (mean age = 66.5 years), 369 provided responses and 28% were concordant. Prognostic concordance was associated with greater caregiver depressive symptoms (β = 0.30; p = .04) but not distress or QoL. A significant moderation effect for caregiver depressive symptoms was found between concordance and mastery (p = .01). Specifically, among caregivers with low mastery (below median), concordance was associated with greater depressive symptoms (β = 0.68; p = .003). Conclusions Caregiver–oncologist prognostic concordance was associated with caregiver depressive symptoms. We found a novel moderating effect of caregiver mastery on the relationship between concordance and caregiver depressive symptoms. Implications for Practice Caregiver–oncologist prognostic concordance is associated with greater caregiver depressive symptoms, particularly in those with low caregiver mastery. When discussing prognosis with caregivers, physicians should be aware that prognostic understanding may affect caregiver psychological health and should assess their depressive symptoms. In addition, while promoting accurate prognostic understanding, physicians should also identify strengths and build resilience among caregivers.

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Association Between Symptom Burden and Physical Function in Older Patients with Cancer

Cited by 47 publications

References 44 publications

Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer

Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer

Examination of individual and multiple comorbid conditions and health-related quality of life in older cancer survivors

Caregiver–Oncologist Prognostic Concordance, Caregiver Mastery, and Caregiver Psychological Health and Quality of Life

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