Cancer survivors, especially older cancer survivors, have reported poor physical function associated with falls, reduced ability to live independently, and worse overall health. In a recent JAMA Oncology article, Dr Feliciano and colleagues compared the long-term trajectories of physical function decline among older survivors to those of age-matched, cancer-free controls.
The study examined trajectories of physical function scores from a large cohort of postmenopausal women from the Women’s Health Initiative over 2 decades, before and after cancer diagnosis. Women with cancer (n = 9,203) were matched with controls (n = 45,358) on age, enrollment year, and participation in various study components. The mean age at cancer diagnosis was 73 years. The study found that women with local cancers had similar physical function decline to controls, while cancer survivors with regional-stage cancers or those who received systemic therapy experienced accelerated decline in physical function, especially in the first year after diagnosis. Their physical function remained below that of age-matched controls even 5 years or more after diagnosis. The greatest impact was found in women with newly diagnosed lung cancer, who had the steepest drop in physical function in the first year after diagnosis and lower physical function compared with controls in long-term trajectories.
Longer-term rates of decline varied by cancer type, treatment, and stage. For example, those with colorectal cancer had estimated physical function similar to age-matched controls by 5 years postdiagnosis, while those with breast, endometrial, or lung cancer continued to have significant functional deficits even 5 years after diagnosis.
The authors proposed possible explanations for the accelerated rate of physical function decline in this population, such as the increased symptom burden of regional disease compared with local disease, leading to cancer-related fatigue, deconditioning, and impaired function. Chemotherapy-related adverse events such as fatigue, nausea, and neuropathy may also affect a woman’s ability to function physically. Additionally, cancer treatments may cause lasting functional aging deficits due in part to biologic changes such as cellular senescence, stem cell exhaustion, DNA damage, and epigenetic alterations.
The authors estimated accelerated functional aging of approximately 1 year for women with local breast cancer and 3 years for those with regional breast cancer, with similar results observed in survivors of endometrial cancer. It will be important for future research to verify whether these results may be generalized to younger patients and men. From a population health perspective, future studies are needed to define predictors of physical function trajectories and inform identification of populations for early intervention to help mitigate physical function decline.
Given their increased vulnerability, all patients—but especially postmenopausal women and older cancer survivors with regional cancers—may benefit from supportive interventions to reduce physical function decline. While data in younger cancer survivors and men are not yet available, the results of this study support consideration of the potential for physical function decline when making management decisions for postmenopausal women with common cancers.