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Functional status in older patients with lung cancer: an observational cohort study

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Abstract

Purpose

An assessment of the impact of functional status (FS) evaluated using a combination of Activities of Daily Living (ADL) and the short version of the Instrumental Activities of Daily Living (IADL), on 3- and 6- month mortality and on 3-month unplanned hospitalizations in older patients treated for lung cancers.

Method and objectives

This observational retrospective study was conducted between September 2015 and January 2019 at Marseille University Hospital (AP-HM). During this period, all consecutive outpatients aged 70 years or older referred for a comprehensive geriatric assessment (CGA) before the initiation of lung cancer treatment were enrolled.

Results

Two hundred twenty-seven patients were analyzed: the median age was 78.7 years and 74.0% were male. Almost half of the patients were metastatic (45.4%). Concerning FS, 41.9% of patients had no ADL-IADL impairment, 30.0% had either IADL or ADL impairment, and both ADL-IADL were impaired for 28.1%. Impaired ADL-IADL was associated with poor nutritional status, depression, mobility, and cognitive disorders. In a logistic regression model, ADL or IADL impairment (aOR = 2.1; 95% CI [1.0–4.2]; p = 0.037) and impaired ADL-IADL (aOR = 2.6; 95% CI [1.2–5.3]; p = 0.012) were independently associated with a higher risk of unplanned hospitalizations within 3 months. In the multivariate Cox model, 6-month mortality risk was independently associated with impaired ADL-IADL (aHR = 2.3; 95% CI [1.3–4.4]; p = 0.008).

Conclusion

The combination of ADL and IADL scales to assess FS is a prognostic marker of the mortality risk at 6 months in older patients with lung cancer and should be more largely used by oncologists in treatment decision making.

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Data availability

Material is available on request to the corresponding author.

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Code is available on request to the corresponding author.

References

  1. Owonikoko TK, Ragin CC, Belani CP et al (2007) Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol 25:5570–5577. https://doi.org/10.1200/JCO.2007.12.5435

    Article  PubMed  Google Scholar 

  2. Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2010, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/archive/csr/1975_2010/, based on November 2012 SEER data submission, posted to the SEER web site, April 2013. Accessed 14 Dec 2021

  3. Giroux Leprieur E, Labrune S, Giraud V et al (2012) Delay between the initial symptoms, the diagnosis and the onset of specific treatment in elderly patients with lung cancer. Clin Lung Cancer 13:363–368. https://doi.org/10.1016/j.cllc.2011.11.010

    Article  PubMed  Google Scholar 

  4. Schulkes KJG, Hamaker ME, van den Bos F, van Elden LJR (2016) Relevance of a geriatric assessment for elderly patients with lung cancer-a systematic review. Clin Lung Cancer 17:341-349.e3. https://doi.org/10.1016/j.cllc.2016.05.007

    Article  PubMed  Google Scholar 

  5. Rivera C, Falcoz P-E, Bernard A et al (2011) Surgical management and outcomes of elderly patients with early stage non-small cell lung cancer: a nested case-control study. Chest 140:874–880. https://doi.org/10.1378/chest.10-2841

    Article  PubMed  Google Scholar 

  6. Wildiers H, Heeren P, Puts M et al (2014) International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32:2595–2603. https://doi.org/10.1200/JCO.2013.54.8347

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mohile SG, Dale W, Somerfield MR et al (2018) Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. J Clin Oncol 36:2326–2347. https://doi.org/10.1200/JCO.2018.78.8687

    Article  PubMed  PubMed Central  Google Scholar 

  8. Solomon DH (1988) Geriatric assessment: methods for clinical decision making. JAMA 259:2450–2452

    Article  CAS  PubMed  Google Scholar 

  9. Aliamus V, Adam C, Druet-Cabanac M et al (2011) Geriatric assessment contribution to treatment decision-making in thoracic oncology. Rev Mal Respir 28:1124–1130. https://doi.org/10.1016/j.rmr.2011.04.012

    Article  CAS  PubMed  Google Scholar 

  10. Quoix E (2011) Optimal pharmacotherapeutic strategies for elderly patients with advanced non-small cell lung cancer. Drugs Aging 28:885–894. https://doi.org/10.2165/11595100-000000000-00000

    Article  PubMed  Google Scholar 

  11. Fiteni F, Anota A, Westeel V, Bonnetain F (2016) Methodology of health-related quality of life analysis in phase III advanced non-small-cell lung cancer clinical trials: a critical review. BMC Cancer 16:122. https://doi.org/10.1186/s12885-016-2152-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Gridelli C, Balducci L, Ciardiello F et al (2015) Treatment of elderly patients with non-small-cell lung cancer: results of an international expert panel meeting of the Italian Association of Thoracic Oncology. Clin Lung Cancer 16:325–333. https://doi.org/10.1016/j.cllc.2015.02.006

    Article  PubMed  Google Scholar 

  13. Corre R, Greillier L, Le Caër H et al (2016) Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase III randomized ESOGIA-GFPC-GECP 08–02 Study. J Clin Oncol 34:1476–1483. https://doi.org/10.1200/JCO.2015.63.5839

    Article  CAS  PubMed  Google Scholar 

  14. Karampeazis A, Vamvakas L, Kotsakis A et al (2017) Docetaxel plus gemcitabine versus gemcitabine in elderly patients with advanced non-small cell lung cancer and use of a geriatric assessment: lessons from a prematurely closed Hellenic Oncology Research Group randomized phase III study. J Geriatr Oncol 8:23–30. https://doi.org/10.1016/j.jgo.2016.05.002

    Article  PubMed  Google Scholar 

  15. Ruiz J, Miller AA, Tooze JA et al (2019) Frailty assessment predicts toxicity during first cycle chemotherapy for advanced lung cancer regardless of chronologic age. J Geriatr Oncol 10:48–54. https://doi.org/10.1016/j.jgo.2018.06.007

    Article  PubMed  Google Scholar 

  16. Maestu I, Munoz J, Gomez-Aldaravi L et al (2007) Assessment of functional status, symptoms and comorbidity in elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with gemcitabine and vinorelbine. Clin Transl Oncol 9:99–105. https://doi.org/10.1007/s12094-007-0019-2

    Article  CAS  PubMed  Google Scholar 

  17. Biesma B, Wymenga ANM, Vincent A et al (2011) Quality of life, geriatric assessment and survival in elderly patients with non-small-cell lung cancer treated with carboplatin-gemcitabine or carboplatin-paclitaxel: NVALT-3 a phase III study. Ann Oncol 22:1520–1527. https://doi.org/10.1093/annonc/mdq637

    Article  CAS  PubMed  Google Scholar 

  18. Decoster L, Kenis C, Schallier D et al (2017) Geriatric assessment and functional decline in older patients with lung cancer. Lung 195:619–626. https://doi.org/10.1007/s00408-017-0025-2

    Article  CAS  PubMed  Google Scholar 

  19. Couderc A-L, Boulahssass R, Nouguerede E et al (2019) Functional status in a geriatric oncology setting: a review. J Geriatr Oncol 10:884–894. https://doi.org/10.1016/j.jgo.2019.02.004

    Article  PubMed  Google Scholar 

  20. Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged. Index of ADL: A Standardized Measure of Biological and Psychosocial Function. JAMA 185:914–919

    Article  CAS  PubMed  Google Scholar 

  21. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Article  CAS  PubMed  Google Scholar 

  22. Barberger-Gateau P, Dartigues JF, Letenneur L (1993) Four Instrumental Activities of Daily Living Score as a predictor of one-year incident dementia. Age Ageing 22:457–463

    Article  CAS  PubMed  Google Scholar 

  23. Quoix E, Zalcman G, Oster J-P et al (2011) Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. Lancet 378:1079–1088. https://doi.org/10.1016/S0140-6736(11)60780-0

    Article  CAS  PubMed  Google Scholar 

  24. Soubeyran P, Bellera C, Goyard J et al (2014) Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS ONE 9:e115060. https://doi.org/10.1371/journal.pone.0115060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  CAS  PubMed  Google Scholar 

  26. Guigoz Y, Vellas B, Garry PJ (1994) Mini nutritional assessment: A practical assessment tool for grading the nutritional state of elderly patients. Facts and Research in Gerontology Issue SUPPL 2:15–59

  27. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198. https://doi.org/10.1016/0022-3956(75)90026-6

    Article  CAS  PubMed  Google Scholar 

  28. Yesavage JA (1988) Geriatric Depression Scale. Psychopharmacol Bull 24:709–711

    CAS  PubMed  Google Scholar 

  29. Friedman PJ, Richmond DE, Baskett JJ (1988) A prospective trial of serial gait speed as a measure of rehabilitation in the elderly. Age Ageing 17:227–235. https://doi.org/10.1093/ageing/17.4.227

    Article  CAS  PubMed  Google Scholar 

  30. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x

    Article  CAS  PubMed  Google Scholar 

  31. Vellas BJ, Wayne SJ, Romero L et al (1997) One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc 45:735–738. https://doi.org/10.1111/j.1532-5415.1997.tb01479.x

    Article  CAS  PubMed  Google Scholar 

  32. Overcash JA, Rivera HR (2008) Physical performance evaluation of older cancer patients: a preliminary study. Crit Rev Oncol Hematol 68:233–241. https://doi.org/10.1016/j.critrevonc.2008.07.001

    Article  PubMed  Google Scholar 

  33. Puts MTE, Monette J, Girre V et al (2013) The fall rate of older community-dwelling cancer patients. Support Care Cancer 21:775–783. https://doi.org/10.1007/s00520-012-1579-4

    Article  PubMed  Google Scholar 

  34. Stone CA, Lawlor PG, Savva GM et al (2012) Prospective study of falls and risk factors for falls in adults with advanced cancer. J Clin Oncol 30:2128–2133. https://doi.org/10.1200/JCO.2011.40.7791

    Article  PubMed  Google Scholar 

  35. Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:601. https://doi.org/10.1093/ageing/afz046

    Article  PubMed  PubMed Central  Google Scholar 

  36. Miller MD, Paradis CF, Houck PR et al (1992) Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res 41:237–248. https://doi.org/10.1016/0165-1781(92)90005-n

    Article  CAS  PubMed  Google Scholar 

  37. Wildes TM, Dua P, Fowler SA et al (2015) Systematic review of falls in older adults with cancer. J Geriatr Oncol 6:70–83. https://doi.org/10.1016/j.jgo.2014.10.003

    Article  PubMed  Google Scholar 

  38. Sattar S, Alibhai SMH, Spoelstra SL et al (2016) Falls in older adults with cancer: a systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 24:4459–4469. https://doi.org/10.1007/s00520-016-3342-8

    Article  PubMed  Google Scholar 

  39. Sattar S, Haase K, Kuster S et al (2021) Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 29:21–33. https://doi.org/10.1007/s00520-020-05619-2

    Article  CAS  PubMed  Google Scholar 

  40. Pallis AG, Wedding U, Lacombe D et al (2010) Questionnaires and instruments for a multidimensional assessment of the older cancer patient: what clinicians need to know? Eur J Cancer 46:1019–1025. https://doi.org/10.1016/j.ejca.2010.01.006

    Article  CAS  PubMed  Google Scholar 

  41. Xue D, Han S, Jiang S et al (2015) Comprehensive geriatric assessment and traditional Chinese medicine intervention benefit symptom control in elderly patients with advanced non-small cell lung cancer. Med Oncol 32:114. https://doi.org/10.1007/s12032-015-0563-5

    Article  PubMed  Google Scholar 

  42. Maione P, Perrone F, Gallo C et al (2005) Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 23:6865–6872. https://doi.org/10.1200/JCO.2005.02.527

    Article  PubMed  Google Scholar 

  43. Kenis C, Decoster L, Bastin J et al (2017) Functional decline in older patients with cancer receiving chemotherapy: a multicenter prospective study. J Geriatr Oncol 8:196–205. https://doi.org/10.1016/j.jgo.2017.02.010

    Article  PubMed  Google Scholar 

  44. Kiesswetter E, Pohlhausen S, Uhlig K et al (2014) Prognostic differences of the Mini Nutritional Assessment short form and long form in relation to 1-year functional decline and mortality in community-dwelling older adults receiving home care. J Am Geriatr Soc 62:512–517. https://doi.org/10.1111/jgs.12683

    Article  PubMed  Google Scholar 

  45. Satin JR, Linden W, Phillips MJ (2009) Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer 115:5349–5361. https://doi.org/10.1002/cncr.24561

    Article  CAS  PubMed  Google Scholar 

  46. Huo J, Hong Y-R, Xiao H, Wilkie D (2018) The impact of post-diagnosis depression on survival and healthcare costs for patients diagnosed with late-stage cancer in the United States. Value in Health 21:S25–S26. https://doi.org/10.1016/j.jval.2018.04.159

    Article  Google Scholar 

  47. Repetto L, Fratino L, Audisio RA et al (2002) Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 20:494–502. https://doi.org/10.1200/JCO.2002.20.2.494

    Article  PubMed  Google Scholar 

  48. Gajra A, Jatoi A (2014) Non–small-cell lung cancer in elderly patients: a discussion of treatment options. JCO 32:2562–2569. https://doi.org/10.1200/JCO.2014.55.3099

    Article  CAS  Google Scholar 

  49. Hoppe S, Rainfray M, Fonck M et al (2013) Functional decline in older patients with cancer receiving first-line chemotherapy. J Clin Oncol 31:3877–3882. https://doi.org/10.1200/JCO.2012.47.7430

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Internal Medicine, Geriatrics and Therapeutic Unit, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France

    Anne-Laure Couderc, Emilie Nouguerède, Dominique Rey, Coline Montegut & Patrick Villani

  2. Coordination Unit for Geriatric Oncology (UCOG) PACA West, Marseille University Hospital (AP-HM), 270 Boulevard de Sainte Marguerite, 13009, Marseille, France

    Anne-Laure Couderc, Emilie Nouguerède, Dominique Rey, Coline Montegut & Patrick Villani

  3. Aix-Marseille University, CNRS, EFS, ADES, Marseille, France

    Anne-Laure Couderc & Patrick Villani

  4. Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France

    Pascale Tomasini & Laurent Greillier

  5. Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France

    Pascale Tomasini, Laurent Greillier, Pascal-Alexandre Thomas & Fabrice Barlesi

  6. Thoracic Surgery Unit, AP-HM, Marseille, France

    Pascal-Alexandre Thomas

  7. Gustave Roussy Cancer Campus, Villejuif, France

    Fabrice Barlesi

Authors
  1. Anne-Laure Couderc
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  2. Pascale Tomasini
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  3. Laurent Greillier
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  4. Emilie Nouguerède
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  5. Dominique Rey
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  6. Coline Montegut
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  7. Pascal-Alexandre Thomas
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  8. Fabrice Barlesi
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  9. Patrick Villani
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Contributions

Study concepts and design: AL. Couderc, P. Tomasini, D. Rey, E. Nouguerede, C. Montegut, PA. Thomas, F. Barlesi, L. Greillier, P. Villani.

Study material or patients: AL. Couderc, C. Montegut, P Villani. Quality control of data and algorithms: AL. Couderc, D, Rey, E Nouguerede. Data analysis and interpretation: AL. Couderc, D. Rey, E. Nouguerede, P. Villani Statistical analysis: AL. Couderc, D. Rey, E. Nouguerède, P. Villani. Manuscript preparation: AL. Couderc, D. Rey Manuscript editing: AL. Couderc and P. Villani Manuscript review: AL. Couderc, P. Tomasini, D. Rey, E. Nouguerede, C. Montegut, PA. Thomas, F. Barlesi, L. Greillier, P. Villani.

Corresponding author

Correspondence to Anne-Laure Couderc.

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Ethics approval

This study received the approval of the French database and privacy law (Commission Nationale de l’Informatique et Liberté CNIL registration number: 2017–33) and Aix-Marseille University ethics committee. We certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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According to French MR-003 guidelines verbal informed consent was obtained prior to the interview.

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According to French MR-003 guidelines verbal consent for publication was obtained prior to the interview.

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The authors declare no competing interests.

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Couderc, AL., Tomasini, P., Greillier, L. et al. Functional status in older patients with lung cancer: an observational cohort study. Support Care Cancer 30, 3817–3827 (2022). https://doi.org/10.1007/s00520-021-06752-2

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