Abstract
Simple SummaryOlder patients with cancer are more likely to experience a deterioration in their functional status than are their similar-aged, cancer-free counterparts. Such functional decline can be accelerated by cancer treatment. With adequate long-term care comprising routine functional assessment and evidence-based interventions, functional status is likely to be maintained, or the rate of decline slowed. Mitigating the risk of functional decline is vital given its impact on quality of life and mortality.A decline in functional status, an individual’s ability to perform the normal activities required to maintain adequate health and meet basic needs, is part of normal ageing. Functional decline, however, appears to be accelerated in older patients with cancer. Such decline can occur as a result of a cancer itself, cancer treatment-related factors, or a combination of the two. The accelerated decline in function seen in older patients with cancer can be slowed, or even partly mitigated through routine assessments of functional status and timely interventions where appropriate. This is particularly important given the link between functional decline and impaired quality of life, increased mortality, comorbidity burden, and carer dependency. However, a routine assessment of and the use of interventions for functional decline do not typically feature in the long-term care of cancer survivors. This review outlines the link between cancer and subsequent functional decline, as well as potential underlying mechanisms, the tools that can be used to assess functional status, and strategies for its prevention and management in older patients with cancer.
Highlights
Assessment of Functional DeclineFunctional decline is typically assessed through a direct measure of an individual’s capacity to independently fulfil their activities of daily living (ADLs) [1]
A decline in functional status, an individual’s ability to perform the normal activities required to maintain adequate health and meet basic needs, is part of normal ageing
One of the most significant clinical implications of functional decline in older patients with cancer is its impact on health-related quality of life (HRQOL), perhaps best evidenced by the fact that one of the most commonly used tools for measuring HRQOL in patients with cancer, the European Organisation for Research and Treatment (EORTC) Quality of Life Questionnaire–Core 30 (QLQ–C30), features a physical function section [85]
Summary
Functional decline is typically assessed through a direct measure of an individual’s capacity to independently fulfil their activities of daily living (ADLs) [1]. Its development can instead be identified through markers such as nutritional status, physical activity, mobility, energy, strength, cognition, mood, and social support In this regard, the assessment of frailty requires a more comprehensive ‘geriatric assessment’ beyond the assessment of ADLs [8]. These include instruments such as the Barthel index, the Eastern Cooperative Oncology Group performance status (ECOG), the Katz index of independence in activities of daily living scale (ADL), the Instrumental. Provides an online assessment tool for clinicians that combines the KPS scale, TUG, and Blessed Orientation–Memory–Concentration test (a cognitive function assessment aimed at assessing the contribution of cognitive decline on functional ability) [24] These geriatric assessments tend to provide an indication of declines in ADLs, and frailty and the susceptibility of a patient to future disability
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