老年癌症患者的疲劳、身体功能和社会脆弱性

IF 3 3区医学 Q3 GERIATRICS & GERONTOLOGY

Journal of geriatric oncology Pub Date : 2025-05-31 DOI:10.1016/j.jgo.2025.102284

Marielle Jensen-Battaglia , Alan Delmerico , Mostafa Mohamed , Rachael Tylock , Marie Flannery , Brian L. Burnette , Nisarg Desai , Navin Anthony , Karen Mustian , Kah Poh Loh , Supriya G. Mohile , Christopher L. Seplaki , Nikesha Gilmore

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引用次数: 0

摘要

患有癌症相关疲劳的老年人通常会经历身体功能的损害。在个人和社区层面上，健康的社会决定因素（SDOH）可能意味着一些患者处理疲劳的资源较少，并且身体功能下降的风险更大。材料和方法在一项全国性的集群随机临床试验（NCT02054741, UG1CA189961）中，我们分析了年龄≥70岁的晚期癌症患者和≥1种年龄相关损伤患者，这些患者正在开始新的治疗方案，并且具有高风险的毒性。在基线时收集患者报告的结果不良事件通用术语标准（PROC-CTCAE）疲劳严重程度（0-4分），在基线、4-6周、3个月和6个月时收集短体能性能电池（SPPB，一种身体功能测量，0-12分）。患者所在县的SDOH通过社会脆弱性指数（SVI，一种反映社区脆弱性的指标，0到1，高=差）来衡量。我们估计了4-6周SPPB下降≥1点与基线疲劳相关的校正相对风险（RR）。在探索性分析中，我们估计：(1)这种关联在3个月和6个月时，(2)SVI调节了这种关联。结果在718例患者中，我们分析了600例在≥1个随访时间点评估SPPB的患者。一半的人报告疲劳中度或更严重，38.8%的人在4-6周后SPPB下降。平均SVI为0.42 （SD 0.23）。更大的疲劳与4-6周SPPB下降的风险增加相关(RR 1.21；95% CI 1.09, 1.34, p <；0.001)，但不是3个月或6个月。生活在SVI最脆弱四分位数（RR 1.27, 95% CI 1.05, 1.53）和最脆弱四分位数(RR 1.22, 95% CI 0.91, 1.65；p = 0.85)。疲劳与老年晚期癌症患者身体机能下降有关，且不因社会脆弱性而变化。这些结果强调了评估和管理这一人群疲劳的重要性。

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Fatigue, physical function, and the context of social vulnerability for older adults with cancer

Introduction

Older adults with cancer-related fatigue often experience impairments in their physical function. Social determinants of health (SDOH) at the individual and community level may mean some patients have fewer resources to deal with fatigue and are at greater risk for decline in physical function.

Materials and Methods

We analyzed patients age ≥ 70 with advanced cancer and ≥ 1 aging-related impairment who were starting new treatment regimens with a high risk of toxicity in a nationwide cluster-randomized clinical trial (NCT02054741, UG1CA189961). Patient-Reported Outcome Common Terminology Criteria for Adverse Events (PROC-CTCAE) fatigue severity (0–4 points) was collected at baseline, Short Physical Performance Battery (SPPB, a measure of physical function, 0–12 points) at baseline, 4–6 weeks, 3 months, and 6 months. SDOH in the county where patients lived were measured by the Social Vulnerability Index (SVI, a measure reflecting community vulnerability, 0 to 1, higher = worse). We estimated adjusted relative risk (RR) of ≥1 point SPPB decline at 4–6 weeks associated with baseline fatigue. In exploratory analyses we estimated: (1) this association at 3 and 6 months, (2) moderation of this association by SVI.

Results

Out of 718 patients, we analyzed 600 with SPPB assessed at ≥1 follow up timepoint. Half reported fatigue that was moderate or greater, and 38.8 % declined in SPPB by 4–6 weeks. Mean SVI was 0.42 (SD 0.23). Greater fatigue was associated with increased risk of SPPB decline at 4–6 weeks (RR 1.21; 95 % CI 1.09, 1.34, p < 0.001), but not 3 or 6 months. The association at 4–6 weeks was not significantly different for patients living in areas with the least vulnerable quartile of SVI (RR 1.27, 95 % CI 1.05, 1.53) vs. the most vulnerable (RR 1.22, 95 % CI 0.91, 1.65; p = 0.85).

Discussion

Fatigue is associated with decline in physical function among older adults with advanced cancer and does not vary by social vulnerability. These results emphasize the importance of assessing and managing fatigue in this population.

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来源期刊

Journal of geriatric oncology ONCOLOGY-GERIATRICS & GERONTOLOGY

CiteScore

5.30

自引率

10.00%

发文量

379

审稿时长

80 days

期刊介绍： The Journal of Geriatric Oncology is an international, multidisciplinary journal which is focused on advancing research in the treatment and survivorship issues of older adults with cancer, as well as literature relevant to education and policy development in geriatric oncology. The journal welcomes the submission of manuscripts in the following categories: • Original research articles • Review articles • Clinical trials • Education and training articles • Short communications • Perspectives • Meeting reports • Letters to the Editor.