Comparison of changes in physical functioning of elderly patients with newdiagnoses of cancer

BACKGROUND. Controversy surrounds the impact of site of cancer and treatmen ts on functioning of elderly cancer patients. OBJECTIVES. This research determines (1) whether age, gender, comorbid cond itions, site and stage of cancer, and treatments are related to losses in p hysical functioning at 4 observations during the year after diagnosis; (2) whether symptoms are a mediating variable between treatment and function; a nd (3) which indicators account for hue change in functioning in the year a fter diagnosis. METHODS. An inception cohort of 907 patients aged greater than or equal to 65 years and newly diagnosed with breast, colon, lung, or prostate cancer w ere accrued from 24 community oncology programs. Stage and treatment data w ere obtained from medical records. Physical functioning was measured with t he SF-36 subscale. Interviews were conducted at 6 to 8,12 to 16, 26 to 30, and 52 weeks after diagnosis. RESULTS. Men scored 10 points higher on physical function than women at all observation points. Patients with greater than or equal to 3 comorbid cond itions scored lower in functioning. Interactions between site of cancer and treatment modalities were observed. Pain, fatigue, and numbers of symptoms were independent predictors of loss of function. Surgery, female gender, a nd number of symptoms predicted reliable change in function. CONCLUSIONS. Elderly patients with cancer report levels of function similar to other chronic conditions. Scores on physical function varied by site of cancer; the pattern of change was similar among sites. Age, comorbidity, t reatment modalities, and symptom reports each had an independent effect on loss of functioning. Untreated breast cancer patients had lower functioning , suggesting a possible treatment bias.