A reduced physical function is a well-known marker of ageing. Interestingly, a recent study in JAMA Oncology showed that postmenopausal female cancer survivors experience a faster decline in physical functioning than women without cancer. As such, rehabilitation programmes that could help these cancer survivors are urgently needed.
A decline in physical functioning is typical for all ageing individuals, including cancer survivors. Studies have shown that cancer treatment can accelerate the biological processes associated with ageing. However, the long-term consequences of cancer treatment on the physical function of cancer patients are not well studied. Elizabeth et al. have used data from the National Women’s Health Initiative (WHI) study and WHI’s Life and Longevity After Cancer study to address this critical question.
This prospective cohort study analysed the physical function of 9,203 cancer survivors included in the WHI between 1993 and 1998 and followed up until December 2022. These survivors consisted of breast (n= 5,989), colorectal (n= 1,352), endometrial (n= 960) and lung cancer (n= 902) patients. Each cancer survivor was matched to 5 controls (n= 45,358) with a similar age/year of enrolment and study arm. The study’s main outcome was self-reported physical functioning measured using the RAND short form 36 (range: 0-100; higher scores indicate superior physical functioning).
The analysis revealed a decline in physical function after cancer treatment among cancer survivors. This decline was more pronounced in women with regional cancer (5.3 points/ year [95% CI, 6.4 to 4.3]) than in patients with local breast cancer (2.8 points [95% CI, -3.4 to 2.3]). The decline was exceptionally high in women with local endometrial cancer who underwent systemic therapy with any chemotherapy (7.9 points/year [95% CI, 12.2 to 3.6]. Among endometrial cancer patients who received only radiation therapy this decline was 3.1 points/year (95% CI, 6 to 0.3), while it was 2.6 points among patients who received neither therapy (2.6 points/year [95% CI, 4.2 to 1]).
These findings clearly illustrate the negative impact of cancer treatment on the physical function of cancer survivors. Future research will be needed to develop survivorship programmes that can help cancer survivors to mitigate or reverse these declines in physical functioning.
Cespedes Feliciano EM, Vasan S, Luo J, et al. Long-term Trajectories of Physical Function Decline in Women With and Without Cancer. JAMA Oncol. Published online January 19, 2023.