女性癌症患者和非癌症患者身体功机下降的长期轨迹

SCI 1 February 2023

Long-term Trajectories of Physical Function Decline in Women With and Without Cancer

 ( IF: Jama Oncol., 33.006)

Cespedes Feliciano EM, Vasan S, Luo J, Binder AM, Chlebowski RT, Quesenberry C, Banack HR, Caan BJ, Paskett ED, Williams GR, Barac A, LaCroix AZ, Peters U, Reding KW, Pan K, Shadyab AH, Qi L, Anderson GL. Long-term Trajectories of Physical Function Decline in Women With and Without Cancer. JAMA Oncol. 2023 Jan 19. 

Corresponding Author: Elizabeth M. Cespedes Feliciano, ScD SM, Kaiser Permanente Northern California Division of Research, 2000 Broadway, 5th Floor, 051R16, Oakland, CA 94612 (elizabeth.m. cespedes@kp.org).

IMPORTANCE 重要性  

Patients with cancer experience acute declines in physical function, hypothesized to reflect accelerated aging driven by cancer-related symptoms and effects of cancer therapies. No study has examined long-term trajectories of physical function by cancer site, stage, or treatment compared with cancer-free controls.

癌症患者会经历身体机能急剧下降，推测这反映了癌症相关症状和癌症治疗效果导致的加速衰老。与无癌对照组相比，尚没有研究根据癌症部位、阶段或治疗检查身体功能的长期轨迹。

OBJECTIVE 目的  

Examine trajectories of physical function a decade before and after cancer diagnosis among older survivors and cancer-free controls.

检查老年幸存者和无癌对照者在诊断出癌症前后十年的身体机能轨迹。

DESIGN, SETTING, AND PARTICIPANTS 设计、设置与参与者  

This prospective cohort study enrolled patients from 1993 to 1998 and followed up until December 2020. The Women’s Health Initiative, a diverse cohort of postmenopausal women, included 9203 incident cancers (5989 breast, 1352 colorectal, 960 endometrial, and 902 lung) matched to up to 5 controls (n = 45 358) on age/year of enrollment and study arm.

这项前瞻性队列研究招募了1993年至1998年的患者，并随访至2020年12月。妇女健康倡议是一个多元化的绝经后妇女队列，包括9203例新发癌症（5989例乳腺癌、1352例结直肠癌、960例子宫内膜癌和902例肺癌），以及在年龄/入组年份和研究组方面匹配到了多达5个对照组（n=45358）。

EXPOSURES 公开  

Cancer diagnosis (site, stage, and treatment) via Medicare and medical records.

通过医疗保险和医疗记录进行癌症诊断（部位、阶段和治疗）。

MAIN OUTCOMES AND MEASURES 主要结果与方法  

Trajectories of self-reported physical function (RAND Short Form 36 [RAND-36] scale; range: 0-100, higher scores indicate superior physical function) estimated from linear mixed effects models with slope changes at diagnosis and 1-year after diagnosis.

根据诊断时和诊断后1年的斜率变化的线性混合效应模型估计的自我报告的身体机能轨迹（RAND简表36[RAND-36]量表；范围：0-100，得分越高表示身体机能越好）。

RESULTS 结果  

This study included 9203 women with cancer and 45 358 matched controls. For the women with cancer, the mean (SD) age at diagnosis was 73.0 (7.6) years. Prediagnosis, physical function declines of survivors with local cancers were similar to controls; after diagnosis, survivors experienced accelerated declines relative to controls, whose scores declined 1 to 2 points per year. Short-term declines in the year following diagnosis were most severe in women with regional disease (eg, −5.3 [95% CI, −6.4 to −4.3] points per year in regional vs −2.8 [95% CI, −3.4 to −2.3] for local breast cancer) or who received systemic therapy (eg, for local endometrial cancer, −7.9 [95% CI, −12.2 to −3.6] points per year with any chemotherapy; −3.1 [95% CI, −6.0 to −0.3] with radiation therapy alone; and −2.6 [95% CI, −4.2 to −1.0] with neither, respectively). While rates of physical function decline slowed in the later postdiagnosis period (eg, women with regional colorectal cancer declined −4.3 [95% CI, −5.9 to −2.6] points per year in the year following diagnosis vs −1.4 [95% CI, −1.7 to −1.0] points per year in the decade thereafter), survivors had estimated physical function significantly below that of age-matched controls 5 years after diagnosis.

这项研究囊括了9203名患有癌症的女性和45358名匹配的对照组。对于患有癌症的女性，诊断时的平均年龄（SD）为73.0（7.6）岁。患有局部癌症的幸存者的诊断前、身体机能下降与对照组相似；诊断后，幸存者相对于对照组经历了加速下降，后者的分数每年下降1到2分。诊断后一年的短期下降在患有局部疾病的女性中最为严重（例如，局部疾病患者每年−5.3[95% CI，−6.4至−4.3]分，对比局部乳腺癌症患者为−2.8[95% CI，−3.4至−2.3]），或接受过全身治疗的女性（例如，对于局部子宫内膜癌患者，任何化疗，每年−7.9[95% CI，−12.2至−3.6]分；单纯放疗−3.1[95% CI，−6.0至−0.3]；以及−2.6[95% CI，−4.2至−1.0]，两者均没有）。虽然在诊断后的后期，身体机能下降的速度有所减缓（例如，患有局部结直肠癌的女性在诊断后一年中每年下降-4.3[95% CI，-5.9至-2.6]分，而在诊断后十年每年下降-1.4[95% CI、-1.7至-1.0]分），然而幸存者的身体机能在诊断后5年明显低于同龄对照组。

CONCLUSIONS AND RELEVANCE 结论与意义  

In this prospective cohort study, survivors of cancer experienced accelerated declines in physical function after diagnosis, and physical function remained below that of age-matched controls even years later. Patients with cancer may benefit from supportive interventions to preserve physical functioning.

在这项前瞻性队列研究中，癌症幸存者在诊断后经历了身体机能的加速下降，甚至在几年后身体机能仍低于年龄匹配的对照组。癌症患者可能会从支持性干预措施中受益，以保持身体机能。