Prevalence of functional limitations more than doubles among cancer survivors
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Key takeaways:
- The 70% prevalence among cancer survivors appeared almost twice as high as that of the general population.
- Hispanic and Black cancer survivors had the greatest increase in functional limitation prevalence.
The number of cancer survivors with self-reported functional limitations throughout the United States has more than doubled over the past 2 decades, according to data published in JAMA Oncology.
Survivors of pancreatic and lung cancers had the highest adjusted prevalence of functional limitation during the 20-year study period, whereas survivors of melanoma, breast and prostate cancers had the lowest prevalence, researchers wrote.
“The magnitude of the trend that we found was the most striking, and sobering, aspect of the study,” Vishal R. Patel, BS, a student at Dell Medical School at The University of Texas at Austin, told Healio. “Specifically, the fact that approximately 70% of cancer survivors today report limited function, and that this number amounts to 8 million such individuals means that there remains a lot of work to be done to ensure that patients diagnosed with cancer can return to a sense of normalcy — survival alone is not enough.”
Background and methodology
Treatment for cancer can lead to functional limitations for some patients, an indicator of health associated with impaired quality of life and an economic burden.
Researchers used the National Health Interview Survey to examine 20-year trends in prevalence of self-reported functional limitations among U.S. adult cancer survivors between 1999 and 2018.
The cross-sectional survey defined functional limitation as self-reported difficulty performing any number of 12 routine physical or social activities without assistance.
Researchers computed the risk-adjusted period prevalence of functional limitation to account for several variables, including age, sex, self-reported race and ethnicity, education, insurance, income, survey year, region, cancer site and time elapsed since diagnosis.
They identified 51,258 cancer survivors (60.2% women; 55.4% aged at least 65 years), which represented a weighted population of approximately 178.8 million.
Results
Among the weighted survivors, 3.6 million had reported functional limitations in 1999, and the number increased 2.25-fold to 8.2 million in 2018.
Meanwhile, the number of limitation-free survivors increased 1.34-fold over the same time span, while the number of cancer-free individuals with functional limitations increased 1.6-fold.
The adjusted prevalence of functional limitations among survivors of cancer increased from 57% to 70.1% over the 20-year period (95% CI, 12.5-13.6). Such a change appeared to be most significant for those who self-reported as Hispanic (25.1%) and Black (19.4%), as well as those aged 55 to 64 years (17.2%).
Over the study period, the adjusted prevalence of functional limitations appeared highest among cancer survivors of pancreatic (80.3%) and lung cancers (76.5%) and lowest for survivors of melanoma (62.2%), breast (61.8%) and prostate (59.5%) cancers.
Next steps
The high prevalence of functional limitations among cancer survivors when compared with the general population raises concerns about the current treatment of certain cancers, according to researchers.
“Understanding the exact reason why cancer survivors are more commonly experiencing poor functional outcomes (ie, ability to stand, walk, go to social activities, etc.) is difficult,” Patel told Healio. “It is reasonably likely to assume that at least some portion of this trend can be attributed to cancer treatment, which can take a toll on patients. Moving forward, it will be essential to incorporate function as a core endpoint in clinical trials meant to evaluate the efficacy of novel therapies. Although survival is often prioritized as the most important outcome in clinical trials, for many patients, avoiding functional impairment is an equal if not greater priority than survival.”
For more information:
Vishal R. Patel, BS, can be reached at Dell Medical School, 1501 Red River St., Austin, TX 78712; email: vishpatel97@utexas.edu.
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