Physical Functioning Worse, Depression Elevated, in Some Older Survivors, Study Finds

Corinne R. Leach, PhD, MPH, MS

Corinne R. Leach, PhD, MPH, MS

Older patients with cancer experience greater declines in physical functioning, according to a recent study published in the journal Cancer. Further, these patients also were at an increased risk of depression.

The study, led by Corinne R. Leach, PhD, MPH, MS, director of Cancer and Aging Research with the American Cancer Society, sought to answer a simple question: Does cancer create or worsen health problems in older patients?

A better understanding of the connection between cancer and health problems found in old age may allow clinicians to provide patients with an accurate picture of what to expect, as well as recommend preventive measures and exercises to slow down or stop other health problems from occurring.

“This prospective analysis used a propensity score matched control group to cancer cases that enabled us to tease apart the effects of cancer and aging in a novel way,” Leach explained in a statement.

The research team surveyed 4605 individuals without cancer as well as 921 older patients with the most common forms of cancer in older adults (prostate, lung, breast, or colorectal cancer), excluding those with in situ or stage IV disease,

Patients with cancer were initially assessed in 1998 and 2001 and then completed a follow-up assessment 2 years later. Every patient was matched with five controls without cancer but who were similar in their education levels, sex, age, race/ethnicity, marital status, smoking status, and preexisting health conditions.

Participants were evaluated based on health conditions they already had, newly diagnosed health conditions, and overall functionality in day-to-day life. Activities of Daily Living (ADL) for this study included bathing, dressing, eating, getting in or out of chairs, walking, and using the toilet.

The most significant changes from the baseline assessment to follow-up were among patients with lung cancer, who reported difficulty with or inability to perform bathing (12% at baseline to 22% at follow-up), dressing (8% to 19%), eating (5% to 14%), and getting in and out of chairs (21% to 34%). According to study authors, “only the patients with lung cancer reported larger overall declines in sum ADLs compared with the control group.”

Participants also were assessed on the appearance of depression, urinary incontinence, arthritis, and sensory impairments. Researchers found that patients with colorectal cancer and prostate cancer proved to be most at risk for experiencing Major Depressive Disorder (MDD). Patients with prostate cancer also suffered more from urinary incontinence, as difficulty maintaining bladder control increased from 23% to 41%. Other cancer groups experienced little change in these areas.

Although minor changes were noted in the prevalence of arthritis, as well as hearing and sight problems, the changes were not large enough to be considered statistically significant. Changes in preexisting health conditions, such as arthritis and neuropathy, were also examined, though none of the results demonstrated a link between cancer and these issues.

Future research is needed to evaluate the relationship between cancer and other health conditions related not only to aging, but in younger patients as well.

“Decreased physical functioning among older patients with cancer is an important finding for clinicians because it is also actionable,” said Leach. “Healthcare providers need to recommend interventions, such as home-based diet and exercise, for preserving physical function to limit the declines among older patients with cancer. Furthermore, healthcare providers need to improve the coordination of care so that patients and families are prepared for the changes in functioning levels.”

Leach CR, Bellizzi KM, Hurria A, Reeve BB. Is it my cancer or am I just getting older? Impact of cancer on age-related health conditions of older cancer survivors [published online before print May 9, 2016]. Cancer.