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Kathryn E. Weaver, Corinne R. Leach, Xiaoyan Leng, Suzanne C. Danhauer, Heidi D. Chlebowski, Mara Z. The physical functioning subscale of the RAND was the primary outcome. Analysis of covariance was used to examine the effect of cancer history on physical function, with and without adjustment for covariates. In adjusted models, women with a history of cancer reported ificantly lower mean physical functioning In these models, younger current age, lower body mass index, increased physical activity, higher self-rated health, increased reported happiness, and the absence of noncancer comorbid conditions were all associated with higher physical functioning in both women with and without a history of cancer.
Women older than 80 years of age with a cancer history have only a moderately lower level of physical function than comparably aged women without a cancer history. Factors associated with higher levels of physical functioning were similar in both groups. It is estimated that there are 1.
Despite the large of older female survivors, there is very little research characterizing the implications of cancer diagnosis and treatment on the physical and emotional well-being of these women.
Available evidence suggests that older cancer survivors report more limitations in physical functioning and greater disability than age-matched, noncancer controls 2—4. Cancer diagnosis and treatment, in general, across age groups is often associated with higher comorbidity burden and poorer self-rated health later in life 23.
Risk factors for declines in physical health and functioning are varied, but include increased age, comorbid conditions, and physical performance limitations at the time of diagnosis 56. The trajectory of declines in self-rated health and function are not clear postdiagnosis, but may be most pronounced in the first few years after cancer diagnosis 478.
In fact, recent studies of older cancer survivors suggest that physical limitations are more closely associated with presence of comorbidities than duration of survivorship 9. Further, Cohen and colleagues 10 suggest that the impact of cancer and its treatments may be attenuated over time and largely replaced by changes related to aging itself, although this has been debated In this age group, it is largely unknown how a prior diagnosis of cancer affects physical functioning and overall health in the context of other comorbid conditions associated with aging.
As one of the largest U. We are also able to add to the literature on physical functioning among older cancer survivors by examining the impact of psychosocial variables such depression and optimism, which have been found to be ificant predictors of Lady 60 to 80 years of age functioning and quality of life in prior studies of older adults with and without chronic medical conditions 12— The WHI is a large longitudinal study ofwomen recruited at 40 clinical centers across the United States from towith both an observational study and randomized clinical trials of estrogen plus progestin, estrogen alone, dietary modification, and calcium and vitamin D supplementation 15 Women were 50—79 years of age and postmenopausal at study entry.
The composition of this cohort is described in detail earlier in this special issue Beavers and colleagues. Reports of any cancer diagnoses were elicited every 6 months. Cancers were then confirmed by medical record and pathology report review by trained physicians at each clinic and were centrally adjudicated by reviewers. Those women with a cancer diagnosis 18excluding cases of nonmelanoma skin cancer, after their enrollment in the WHI were considered to be cancer survivors. Cancer-related variables collected as part of the adjudication process included cancer type and date of cancer diagnosis used to calculate time since most recent cancer diagnosis.
The physical functioning subscale of the RAND item health survey 1920administered at the most current assessment after turning 80, was used as the primary outcome. This subscale score is standardized to a mean of 50 and a standard deviation SD of 10; higher scores indicate better functioning.
The RAND has been used extensively in studies of older adults 21 and distinguishes between older adults with and without chronic disease, including different types of cancer History of noncancer comorbidities yes vs no for each condition was assessed annually using both selfreport diabetes treated with pills or insulin, coronary heart disease, stroke, hip fracture after age 55 years, chronic obstructive pulmonary disease, and osteoarthritis and clinical adjudication for primary WHI outcomes during the main WHI study and the first extension coronary heart disease, stroke, and hip fracture.
Finally, we also included WHI study asment as an additional covariate clinical trial vs observational study. Positive and negative psychosocial variables such depression and optimism have been found to be ificant predictors of physical functioning and quality of life in prior studies of older adults with and without chronic medical conditions 12— Responses for each item were weighted according to the Burnham algorithm with a final range from 0 to 1; higher score indicates greater likelihood of depression.
Optimism was measured using the life orientation test-revised Scores range from 6 to 30, with higher score indicating greater optimism. Subjective happiness was assessed using a single item from the emotional well-being subscale of the Rand asking women about their happiness during the past 4 weeks. The most recent participant assessments after cancer diagnosis were used for depressive symptoms, subjective happiness, and optimism. Comparisons across women with and without a history of cancer were performed using analysis of variance for continuous variables or chi-square tests for categorical variables.
Finally, we also explored possible independent predictors for physical functioning among cancer survivors using an analysis of covariance model, including cancer type, cancer stage, age at first cancer diagnosis and time since most recent cancer diagnosis as described in Table 1. Similar analysis was also performed for women without a cancer history. Least square means and their corresponding SEs were reported from all the analysis of covariance models.
Bold values indicated that the p-value was less than. All analyses were performed using SAS 9. As part of an exploratory analysis, we also examined differences between those women with and without a cancer history for the individual items comprising the physical function scale. Composition of the analytic sample is shown in Figure 1. Among the cancer survivors Table 2most cancers were early stage at diagnosis For the majority of women Composition of the analytic sample of women age 80 years and older with and without a history of cancer.
Cancer survivors were more likely than the no cancer history group to be of non-Hispanic white ethnicity Cancer survivors were also ificantly more likely to report a past history of smoking There were no differences for noncancer comorbidities or psychological variables optimism, subjective happiness, or depression.
Women with a history of cancer reported ificantly lower mean SE physical functioning These mean differences remained statistically ificant and decreased slightly in magnitude in models that adjusted for demographics, health behaviors, health status, and psychological status. In the fully adjusted model, the least square means were There were no ificant differences in physical functioning between survivors with single or multiple cancers in adjusted or unadjusted models not reported.
In general, predictors of physical functioning were similar Lady 60 to 80 years of age women with and without a cancer history unadjusted models shown in Supplementary Table and adjusted models shown in Table 1with no interactions reaching the. All three psychological variables were ificant predictors of physical functioning in the unadjusted model Supplementary Tablebut only subjective happiness remained statistically ificant for both groups in adjusted models. Women with higher happiness reported better physical functioning after age 80 difference between lowest and highest group least square means of 4.
There were no ificant differences in physical functioning by cancer type, time since cancer diagnosis and cancer stage in situ or localized vs regional among the cancer survivors Table 1. Cancer history is associated with poorer self-reported physical functioning among women 80 years of age and older, and adjustment for demographics, health behaviors, health status, and psychological variables does not eliminate this effect. The size of the difference in physical functioning between older women with and without a cancer history 1.
Importantly, these interpretation rules are meant to assess differences over time for one individual, but do not reflect population perspectives that acknowledge that relatively small differences in risk factors or outcomes may have large implications when applied to populations. Very little is known about the meaningfulness about population differences in physical functioning, with most studies relying on interpretation based on individual change metrics.
Predictors of better physical functioning were similar in older women with and without a cancer history in fully adjusted models younger age, increased physical activity, healthy weight, better self-reported health, absence of noncancer comorbidities, and subjective happiness. Many of these same predictors of physical functioning or related constructs such as frailty have been seen in the general population of older adults 26—29 and in other studies of cancer survivors 5 Similar to Bellury and colleagues 5we observed that psychological status in our case, subjective happiness was associated with physical functioning in cancer survivors.
Both optimism and ificant depressive symptoms were ificantly associated with physical functioning in unadjusted, but not adjusted models. Such findings have been ificant even after controlling for sociodemographic variables, health behaviors, depressive symptoms, and negative affect 35 Our provide further evidence that positive emotions are an independent predictor of health outcomes Noncancer comorbidities were important predictors of physical functioning among female survivors 80 years and older.
Our finding is also at odds with other data suggesting higher prevalence of noncancer comorbidities and poorer functional health among African American survivors 39but may be explained by survival bias. By de, this study excluded women who did not survive to age 80, survivors who entered the WHI with a history of cancer, and women with advanced stage disease. However, our findings are relevant to those females aged 80 and above who are increasingly seen in oncology follow-up clinics and primary care clinics for on-going survivorship care.
Study limitations include lack of information on cancer therapy, recurrence, and permanent bodily changes due to cancer. Objectively measured physical performance was available for only a small subset of participants and could not be used in the present analyses; future analyses incorporating this additional data could provide additional insight into differences in physical function between octagenarians with and without a cancer history.
Longitudinal studies that examine trajectories of physical functioning and health behaviors may elucidate these complex relationships in older female cancer survivors. Finally, future examination of the relationship between cancer and physical functioning in an expanded cohort including younger women would also be informative.
Understanding the functional consequences of a cancer diagnosis among the oldest old can inform development of individualized survivorship plans. Our study suggests that the oldest cancer survivors may continue to benefit from healthy behaviors to improve physical functioning, including physical activity and maintenance of a healthy weight.
Consideration of psychosocial factors such as happiness may also be important. Overall, our study suggests resilience among the population of older female cancer survivors. Although physical functioning was slightly lower in survivors compared to older women without a cancer history, the differences were smaller than one might expect.
Clinicians caring for these older survivors should continue to remain cognizant of the Lady 60 to 80 years of age role of noncancer comorbidities for survivors in their 80s and beyond. Assessing and addressing health promoting behaviors in female oncology survivors, regardless of age, continue to be important in the preservation of physical functioning, particularly in those 80 years and older.
We gratefully acknowledge the dedicated efforts of the WHI participants and of key WHI investigators and staff at the clinical centers and the Clinical Coordinating Center. Cancer survivors: a booming population. Cancer Epidemiol Biomarkers Prev.
Google Scholar. Cancer survivors in the United States: age, health, and disability. Physical and mental health status of older long-term cancer survivors. J Am Geriatr Soc. Sweeney C et al. Functional limitations in elderly female cancer survivors. J Natl Cancer Inst. Bellury L et al. The effect of aging and cancer on the symptom experience and physical function of elderly breast cancer survivors.
Klepin HD et al. Physical performance and subsequent disability and survival in older adults with malignancy: from the health, aging and body composition study. Ganz PA et al. Breast cancer in older women: quality of life and psychosocial adjustment in the 15 months after diagnosis. J Clin Oncol. Stover AM et al. Quality of life changes during the pre- to postdiagnosis period and treatment-related recovery time in older women with breast cancer.
Function in elderly cancer survivors depends on comorbidities. Impact of age, comorbidity and symptoms on physical function in long-term breast cancer survivors CALGBLady 60 to 80 years of age
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