Aging Cancer Survivors Have Greater Functional Decline

By Lisa Rapaport

September 08, 2021

(Reuters Health) - Older adults who are cancer survivors may experience more rapid functional decline than peers without a history of cancer, a recent study suggests.

Researchers examined data on 1,728 adults aged 22 to 100 years who participated in the Baltimore Longitudinal Study of Aging and underwent functional status evaluations including tests of grip strength, gait speed, and overall physical performance between 2006 and 2019. The analysis included 359 cancer survivors and 1,369 individuals without a history of malignancies.

After adjusting for age, sex, race, BMI, and comorbidities, cancer survivors were significantly more likely to have weak grip strength (adjusted odds ratio 1.42), defined as less than 26kg for men and less than 16kg for women.

Cancer survivors over 65 years old were also significantly more likely to have slow gait speed (aOR 1.61).

Mean physical performance scores on the Health, Aging and Body Composition physical performance battery (HABC PPB) were also lower for cancer survivors (adjusted difference 0.11 units).

"Findings from our study add to the evidence that cancer and its treatment may have adverse effects on aging-related processes, putting cancer survivors at risk for accelerated functional decline," said senior author Lisa Gallicchio, of the National Cancer Institute in Bethesda, Maryland.

"Understanding which cancer survivors are at highest risk, and when the accelerated decline in physical functioning is most likely to begin, is important in developing interventions to prevent, mitigate, or reverse the adverse aging-related effects of cancer and its treatment," Gallicchio said.

Among cancer survivors, prostate cancer was the most common with 139 cases, followed by breast cancer with 61 cases, and melanoma with 54 cases. Participants completed a mean of three visits, with a mean follow-up period of five years.

All the participants had assessments at an index visit. Then, participants had follow-up visits every four years when they were under 60 years old, every two years when they were 60-79 years old, and annually at 80 and up.

The proportion of cancer survivors with a weak grip strength climbed from 11.7% at the index visit to 23.2% by their final assessment, compared with an increase from 9.3% to 16.4% among people without a history of cancer.

The proportion of cancer survivors with a slow gait rose from 6.5% to 8.9% among individuals under 65, and from 40% to 56.3% among cancer survivors over 65 years old.

One limitation of the study is that it didn't assess cancer risk or survivorship, meaning that researchers lacked data on cancer staging, pathology, or treatment regimens, the study team notes in the Journal of the American Geriatrics Society.

Another limitation is that participants with a history of cancer prior to study enrollment had to be cancer-free for at least a decade, meaning their outcomes might not be representative of all cancer survivors. At the index visit for the study, participants also had to be free of chronic diseases, further limiting the generalizability of the results.

SOURCE: Journal of the American Geriatrics Society, online August 3, 2021.