Functional status in older patients with cancer and a frailty risk profile: A multicenter observational study

Published:September 06, 2022DOI:



      Functional status (FS) and frailty are significant concerns for older adults, especially those with cancer. Data on FS (Activities of Daily Living [ADL]; Instrumental Activities of Daily Living [IADL]) and its evolution during cancer treatment in older patients and a frailty risk profile are scarce. Therefore, this study examines FS and its evolution in older patients with cancer and a frailty risk profile and investigates characteristics associated with functional decline.

      Material and Methods

      This secondary data-analysis, focusing on FS, uses data from a large prospective multicenter observational cohort study. Patients ≥70 years with a solid tumor and a frailty risk profile based on the G8 screening tool (score ≤ 14) were included. A geriatric assessment was performed including evaluation of FS based on ADL and IADL. At approximately three months of follow-up, FS was reassessed. Univariable and multivariable logistic regression analyses were used to identify predictive factors for functional decline in ADL and IADL.


      Data on ADL and IADL were available at baseline and follow-up in 3388 patients. At baseline 1886 (55.7%) patients were dependent for ADL, whereas 2085 (61.5%) patients were dependent at follow-up. Functional decline was observed in 23.6% of patients. For IADL 2218 (65.5%) patients were dependent for IADL, whereas 2591 (76.5%) patients were dependent at follow-up. Functional decline in IADL was observed in 41.0% of patients. In multivariable analysis, disease stage III or IV, comorbidities, falls history in the past twelve months, and FS measured by IADL were predictive factors for functional decline in both ADL and IADL. Other predictive factors for functional decline in ADL were polypharmacy, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score 2–4, and cognitive impairment, and for functional decline in IADL were female sex, fatigue, and risk for depression.


      Functional impairments are frequent in older persons with cancer and a frailty risk profile, and several characteristics are identified that are significantly associated with functional decline. Therefore, FS is an essential part of the geriatric assessment which should be standard of care for this patient population. Next step is to proceed with directed interventions with the aim to limit the risk of functional decline as much as possible.


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        • Nightingale G.
        • Battisti N.M.L.
        • Loh K.P.
        • Puts M.
        • Kenis C.
        • Goldberg A.
        • et al.
        Perspectives on functional status in older adults with cancer: an interprofessional report from the International Society of Geriatric Oncology (SIOG) nursing and allied health interest group and young SIOG.
        J Geriatr Oncol. 2021; 12: 658-665
        • Couderc A.L.
        • Suchon P.
        • Saliba-Serre B.
        • Rey D.
        • Nouguerede E.
        • Arcani R.
        • et al.
        Functional status in older patients with cancer.
        J. Geriatr. Oncol. 2022; 13 (Epub 2021 Jul 28. PMID: 34330668): 40-45
        • Kenis C.
        • Bron D.
        • Libert Y.
        • Decoster L.
        • Van Puyvelde K.
        • Scalliet P.
        • et al.
        Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study.
        Ann Oncol. 2013; 24: 1306-1312
        • Kenis C.
        • Decoster L.
        • Bastin J.
        • Bode H.
        • Van Puyvelde K.
        • De Grève J.
        • et al.
        Functional decline in older patients with cancer receiving chemotherapy: A multicenter prospective study.
        J Geriatr Oncol. 2017; 8: 196-205
        • Kenzik K.M.
        • Kent E.E.
        • Martin M.Y.
        • Bhatia S.
        • Pisu M.
        Chronic condition clusters and functional impairment in older cancer survivors: a population-based study.
        J Cancer Surviv. 2016; 10: 1096-1103
        • Puts M.
        • Monette J.
        • Girre V.
        • Wolfson C.
        • Monette M.
        • Batist G.
        • et al.
        Changes in functional status in older newly-diagnosed cancer patients during cancer treatment: A six-month follow-up period. Results of a prospective pilot study.
        J Geriatr Oncol. 2011; 2: 112-120
        • Couderc A.L.
        • Boulahssass R.
        • Nouguerède E.
        • Gobin N.
        • Guérin O.
        • Villani P.
        • et al.
        Functional status in a geriatric oncology setting: A review.
        J Geriatr Oncol. 2019; 10: 884-894
        • Decoster L.
        • Quinten C.
        • Kenis C.
        • Flamaing J.
        • Debruyne P.R.
        • De Groof I.
        • et al.
        Health related quality of life in older patients with solid tumors and prognostic factors for decline.
        J Geriatr Oncol. 2019; 10: 895-903
        • Bruijnen C.
        • van Harten-Krouwel D.
        • Koldenhof J.
        Predictive value of each geriatric assessment domain for older patients with cancer: a systematic review.
        J Geriatr Oncol. 2019; 10: 859-873
        • Loh K.P.
        • Lam V.
        • Webber K.
        • Padam S.
        • Sedrak M.S.
        • Musinipally V.
        • et al.
        Characteristics associated with functional changes during systemic cancer treatments: A systematic review focused on older adults.
        J Natl Compr Cancer Netw. 2021; : 1-8
        • De Celis E.S.P.
        • Li D.
        • Kim H.
        • Sun C.
        • Sedrak M.
        • Fakih M.
        • et al.
        Patient-defined preferences and health outcome prioritization among older adults with cancer starting chemotherapy.
        J Geriatr Oncol. 2019; 10: S27
        • Pinquart M.
        • Duberstein P.R.
        Information needs and decision-making processes in older cancer patients.
        Crit Rev Oncol Hematol. 2004; 51: 69-80
        • Hoppe S.
        • Rainfray M.
        • Fonck M.
        • Hoppenreys L.
        • Blanc J.F.
        • Ceccaldi J.
        • et al.
        Functional decline in older patients with cancer receiving first-line chemotherapy.
        J Clin Oncol. 2013; 31: 3877-3882
        • Morley J.E.
        • Vellas B.
        • van Kan G.A.
        • Anker S.D.
        • Bauer J.M.
        • Bernabei R.
        • et al.
        Frailty consensus: a call to action.
        J Am Med Dir Assoc. 2013; 14: 392-397
        • O’Donovan A.
        • Leech M.
        Personalised treatment for older adults with cancer: the role of frailty assessment.
        Tech Innov Patient Supp Radiat Oncol. 2020; 16: 30-38
        • Kenis C.
        • Decoster L.
        • Flamaing J.
        • Debruyne P.R.
        • De Groof I.
        • Focan C.
        • et al.
        Adherence to geriatric assessment-based recommendations in older patients with cancer: a multicenter prospective cohort study in Belgium.
        Ann Oncol. 2018; 29: 1987-1994
        • Liuu E.
        • Canouï-Poitrine F.
        • Tournigand C.
        • Laurent M.
        • Caillet P.
        • Le Thuaut A.
        • et al.
        Accuracy of the G-8 geriatric-oncology screening tool for identifying vulnerable elderly patients with cancer according to tumour site: the ELCAPA-02 study.
        J Geriatr Oncol. 2014; 5: 11-19
        • Garcia M.V.
        • Agar M.R.
        • Soo W.K.
        • To T.
        • Phillips J.L.
        Screening tools for identifying older adults with cancer who may benefit from a geriatric assessment: A systematic review.
        JAMA Oncol. 2021; 7: 616-627
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Sharma M.
        • Loh K.P.
        • Nightingale G.
        • Mohile S.G.
        • Holmes H.M.
        Polypharmacy and potentially inappropriate medication use in geriatric oncology.
        J Geriatr Oncol. 2016; 7: 346-353
        • Oken M.M.
        • Creech R.H.
        • Tormey D.C.
        • Horton J.
        • Davis T.E.
        • McFadden E.T.
        • et al.
        Toxicity and response criteria of the eastern cooperative oncology group.
        Am J Clin Oncol. 1982; 5: 649-655
        • Lamb S.E.
        • Jørstad-Stein E.C.
        • Hauer K.
        • Becker C.
        Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus.
        J Am Geriatr Soc. 2005; 53: 1618-1622
        • Collins S.L.
        • Moore R.A.
        • McQuay H.J.
        The visual analogue pain intensity scale: what is moderate pain in millimetres?.
        Pain. 1997; 72: 95-97
        • Lee K.A.
        • Hicks G.
        • Nino-Murcia G.
        Validity and reliability of a scale to assess fatigue.
        Psychiatry Res. 1991; 36: 291-298
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Yesavage J.A.
        • Brink T.L.
        • Rose T.L.
        • Lum O.
        • Huang V.
        • Adey M.
        • et al.
        Development and validation of a geriatric depression screening scale: a preliminary report.
        J Psychiatr Res. 1982; 17: 37-49
        • Rubenstein L.Z.
        • Harker J.O.
        • Salvà A.
        • Guigoz Y.
        • Vellas B.
        Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF).
        J Gerontol A Biol Sci Med Sci. 2001; 56: M366-M372
        • Vellas B.
        • Guigoz Y.
        • Garry P.J.
        • Nourhashemi F.
        • Bennahum D.
        • Lauque S.
        • et al.
        The Mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients.
        Nutrition. 1999; 15: 116-122
        • Katz S.
        • Ford A.B.
        • Moskowitz R.W.
        • Jackson B.A.
        • Jaffe M.W.
        Studies of illness in the aged: the index of ADL: A standardized measure of biological and psychosocial function.
        JAMA. 1963; 185: 914-919
        • Lawton M.P.
        • Brody E.M.
        Assessment of older people: self-maintaining and instrumental activities of daily living.
        Gerontologist. 1969; 9: 179-186
        • Deschodt M.
        • Wellens N.I.
        • Braes T.
        • De Vuyst A.
        • Boonen S.
        • Flamaing J.
        • et al.
        Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools.
        Aging Clin Exp Res. 2011; 23: 421-426
        • Geyskens K.
        • De Ridder K.
        • Sabbe M.
        • Braes T.
        • Milisen K.
        • Flamaing J.
        • et al.
        Prediction of functional decline in elderly patients discharged from the accident and emergency department.
        Tijdschr Gerontol Geriatr. 2008; 39: 16-25
        • Kenis C.
        • Decoster L.
        • Van Puyvelde K.
        • De Grève J.
        • Conings G.
        • Milisen K.
        • et al.
        Performance of two geriatric screening tools in older patients with cancer.
        J Clin Oncol. 2014; 32: 19-26
        • McCusker J.
        • Kakuma R.
        • Abrahamowicz M.
        Predictors of functional decline in hospitalized elderly patients: A systematic review.
        J Gerontol: Ser A. 2002; 57: M569-M577
        • Serraino D.
        • Fratino L.
        • Zagonel V.
        Prevalence of functional disability among elderly patients with cancer.
        Crit Rev Oncol Hematol. 2001; 39: 269-273
        • Chakiba C.
        • Bellera C.
        • Etchepare F.
        • Mathoulin-Pelissier S.
        • Rainfray M.
        • Soubeyran P.
        The prognostic value of G8 for functional decline.
        J Geriatr Oncol. 2019; 10: 921-925
        • Soubeyran P.
        • Bellera C.
        • Goyard J.
        • Heitz D.
        • Curé H.
        • Rousselot H.
        • et al.
        Screening for vulnerability in older cancer patients: the ONCODAGE prospective multicenter cohort study.
        PLoS One. 2014; 9e115060
        • van Walree I.C.
        • Scheepers E.
        • van Huis-Tanja L.
        • Emmelot-Vonk M.H.
        • Bellera C.
        • Soubeyran P.
        • et al.
        A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer.
        J Geriatr Oncol. 2019; 10: 847-858
        • Amemiya T.
        • Oda K.
        • Ando M.
        • Kawamura T.
        • Kitagawa Y.
        • Okawa Y.
        • et al.
        Activities of daily living and quality of life of elderly patients after elective surgery for gastric and colorectal cancers.
        Ann Surg. 2007; 246: 222-228
        • De Roo A.C.
        • Li Y.
        • Abrahamse P.H.
        • Regenbogen S.E.
        • Suwanabol P.A.
        Long-term functional decline after high-risk elective colorectal surgery in older adults.
        Dis Colon Rectum. 2020; 63: 75-83
        • Finlayson E.
        • Zhao S.
        • Boscardin W.J.
        • Fries B.E.
        • Landefeld C.S.
        • Dudley R.A.
        Functional status after colon cancer surgery in elderly nursing home residents.
        J Am Geriatr Soc. 2012; 60: 967-973
        • Hurria A.
        • Soto-Perez-de-Celis E.
        • Allred J.B.
        • Cohen H.J.
        • Arsenyan A.
        • Ballman K.
        • et al.
        Functional decline and resilience in older women receiving adjuvant chemotherapy for breast cancer.
        J Am Geriatr Soc. 2019; 67: 920-927
        • Petrick J.L.
        • Reeve B.B.
        • Kucharska-Newton A.M.
        • Foraker R.E.
        • Platz E.A.
        • Stearns S.C.
        • et al.
        Functional status declines among cancer survivors: trajectory and contributing factors.
        J Geriatr Oncol. 2014; 5: 359-367
        • Jacobs B.L.
        • Lopa S.H.
        • Yabes J.G.
        • Nelson J.B.
        • Barnato A.E.
        • Degenholtz H.B.
        Change in functional status after prostate cancer treatment among Medicare advantage beneficiaries.
        Urology. 2019; 131: 104-111
        • Li D.
        • Sun C.L.
        • Kim H.
        • Soto-Perez-de-Celis E.
        • Chung V.
        • Koczywas M.
        • et al.
        Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: A randomized clinical trial.
        JAMA Oncol. 2021; 7e214158
        • Mohile S.G.
        • Mohamed M.R.
        • Xu H.
        • Culakova E.
        • Loh K.P.
        • Magnuson A.
        • et al.
        Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
        Lancet. 2021; 398: 1894-1904