Physical functioning of elderly cancer patients prior to diagnosis and following initial treatment

Background and Objectives: Using an instrument to measure physical function ing that was normed to the U.S. population, data were obtained from patient s with a new diagnosis of breast, colon, lung, and prostate cancer. Two que stions were addressed: (a) after controlling for age, and number of comorbi d conditions, do site and stage of cancer predict functional limitations pr ior to diagnosis; (b) using age adjusted national norms on physical functio ning, how well do age, number of comorbid conditions, stage, treatment and cluster of symptoms (pain, fatigue, and insomnia) explain changes in physic al function between 3 months prior to and 8 weeks following diagnosis? Methods: Patients 65 years of age and older were accrued from 24 community oncology settings. Consenting patients were interviewed within 8 weeks of i nitial treatment. The SF-36 was used to measure physical functioning. Comor bidity and symptom experience were assessed through patient report and site and stage of cancer from record audits. Results: Prior to diagnosis of cancer, patients were comparable in physical functioning to the U.S. population aged 55-64, a full decade younger than the sample of cancer patients. Site and stage of disease did not account fo r variations in physical functioning prior to diagnosis. Compared against n ational norms, patients with more extensive treatments (surgery plus adjuva nt therapy) reported greater loss in functioning. Pain, fatigue, and insomn ia had a consistent and significant effect on losses in functioning unrelat ed to patients' treatments or their comorbid conditions. Conclusions: Site and stage of cancer prior to diagnosis do not affect func tioning. Older cancer patients report higher functioning than their counter parts in the U.S. population. Changes in functioning following diagnosis va ried by cancer site. Treatments were related to loss in functioning, but co morbidity was not. Pain, fatigue, and insomnia were significant and indepen dent predictors of change in patient functioning. This underscores the impo rtance of interventions to manage symptoms early in the course of treatment for individuals.