Women who survive cancer experience faster declines in physical function
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Key findings:
- Declines in physical function, a key marker of aging, occurred faster after cancer treatment among postmenopausal female survivors of all cancer types.
- Five years after their diagnosis, cancer survivors still had lower levels of physical function than women who never had cancer.
Postmenopausal female cancer survivors experienced faster declines in physical function compared with postmenopausal women who never had cancer, according to study results published in JAMA Oncology.
The findings indicate a need for rehabilitation programs that help cancer survivors regain strength and mobility, researchers concluded.
Rationale and methods
“Previous studies have shown that cancer and its treatments can speed up the biological processes that are associated with aging,” Elizabeth M. Cespedes Feliciano, ScD, SM, research scientist in the division of research at Kaiser Permanente Northern California, told Healio. “We were able to use data collected through the landmark, long-term, national Women’s Health Initiative [WHI] study launched in 1991, as well as data from the WHI’s Life and Longevity After Cancer study, to look at trajectories of physical function — a key marker of aging — among women with and without cancer. This resource allowed us to isolate the effects of cancer and its treatments on aging.”
Researchers examined trajectories of physical function 10 years before and after a cancer diagnosis among 9,203 female cancer survivors (median age at diagnosis, 73 years) with breast (n = 5,989), colorectal (n = 1,352), endometrial (n = 960) or lung cancer (n = 902) included in the WHI between 1993 and 1998 compared with 45,358 women who never had cancer. The investigators matches each survivor with up to five controls based on age, year of enrollment and study arm.
Main outcomes included trajectories of self-reported physical function — via RAND Short Form 36 scale at a range between zero and 100, where higher scores indicate superior physical function — estimated from linear mixed-effects models with slope changes at diagnosis and 1 year after diagnosis.
Results
Researchers found that physical function decline occurred faster after cancer treatment among survivors of all cancer types. Of note, they observed variations associated with cancer location and treatment received.
Short-term declines in physical function within 1 year after cancer diagnosis appeared most severe among women with regional cancer (5.3 points per year [95% CI, 6.4 to 4.3] vs. 2.8 points per year [95% CI, -3.4 to 2.3] for local breast cancer) and among women with local endometrial cancer who underwent systemic therapy (7.9 points per year [95% CI, 12.2 to 3.6] with any chemotherapy; 3.1 points per year [95% CI, 6 to 0.3] with radiation therapy alone; and 2.6 points per year [95% CI, 4.2 to 1] with neither therapy).
“There was a sharp decline immediately after a cancer diagnosis — most likely related to treatment — and then physical function continued to decrease, but more gradually,” Cespedes Feliciano said. “We also found that the decline in physical function was persistent. When we looked at cancer survivors 5 years after their diagnosis, they still had lower levels of physical function vs. women who had not had cancer.”
Implications
The findings support the need for more research on cancer survivorship and the best ways to help patients with cancer maintain physical function, Cespedes Feliciano told Healio.
“People with poor physical function have a higher risk for falls and greater difficulty with everyday tasks. It is more difficult for them to live independently,” she said. “Cancer survivorship programs now often include rehabilitation and exercise programs. It will be important to study these programs to determine if they help patients reduce or even reverse declines in physical function. We hope to identify biologic mechanisms and early predictors of accelerated aging that can help us determine which women might benefit most from cancer rehabilitation programs or interventions during treatment to mitigate the effects of aging.”
For more information:
Elizabeth M. Cespedes Feliciano, ScD, SM, can be reached at elizabeth.m.cespedes@kp.org.
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