Carling Ursem1, L Grisell Diaz-Ramirez2, John Boscardin2, Sei Lee2. 1. Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco VA Medical Center, United States of America. Electronic address: Carling.ursem@ucsf.edu. 2. Division of Geriatrics, Department of Medicine, University of California, San Francisco, United States of America.
Abstract
BACKGROUND: Although older men value maintaining independence and avoiding functional decline, little is known about their functional trajectories with receipt of prostate radiation. METHODS: We performed a retrospective cohort study including veterans age 65+ with localized prostate cancer who resided in a VA nursing facility while receiving prostate radiation from 2005 to 2015. We evaluated the change in Minimum Data Set (MDS) activities of daily living (ADL) score during 6 months from the start of treatment. Because prior studies have shown Charlson Comorbidity Index (CCI) to be a strong predictor of treatment-related toxicity, analysis included interaction with CCI. RESULTS: We identified 487 patients with median age 73 (range 65-94). For the average patient in our cohort, the predicted MDS-ADL score worsened from 2.9 (95% CI 2.4-3.6) at the start of radiation to 3.8 (95% CI 3.1-4.8) at 3 months and then 4.5 (95% CI 3.5-5.7) at month 6. Patients with greater comorbidity (CCI ≥ 4) had worse functional outcomes in months 0-3 compared to patients with less comorbidity (CCI 0-3). MDS-ADL score worsened by 1.9 in the CCI ≥4 patients compared to 0.3 in the CCI 0-3 group During months 3-6, patients in both Charlson groups experienced similar worsening of MDS-ADL score. CONCLUSIONS: In a vulnerable population of older patients with localized prostate cancer, radiation was associated with a decline in functional independence. Patients with higher comorbidity experienced more severe functional decline within the first 3 months of radiation therapy. In all comorbidity levels, functional status had not returned to baseline by 6 months. Published by Elsevier Ltd.
BACKGROUND: Although older men value maintaining independence and avoiding functional decline, little is known about their functional trajectories with receipt of prostate radiation. METHODS: We performed a retrospective cohort study including veterans age 65+ with localized prostate cancer who resided in a VA nursing facility while receiving prostate radiation from 2005 to 2015. We evaluated the change in Minimum Data Set (MDS) activities of daily living (ADL) score during 6 months from the start of treatment. Because prior studies have shown Charlson Comorbidity Index (CCI) to be a strong predictor of treatment-related toxicity, analysis included interaction with CCI. RESULTS: We identified 487 patients with median age 73 (range 65-94). For the average patient in our cohort, the predicted MDS-ADL score worsened from 2.9 (95% CI 2.4-3.6) at the start of radiation to 3.8 (95% CI 3.1-4.8) at 3 months and then 4.5 (95% CI 3.5-5.7) at month 6. Patients with greater comorbidity (CCI ≥ 4) had worse functional outcomes in months 0-3 compared to patients with less comorbidity (CCI 0-3). MDS-ADL score worsened by 1.9 in the CCI ≥4 patients compared to 0.3 in the CCI 0-3 group During months 3-6, patients in both Charlson groups experienced similar worsening of MDS-ADL score. CONCLUSIONS: In a vulnerable population of older patients with localized prostate cancer, radiation was associated with a decline in functional independence. Patients with higher comorbidity experienced more severe functional decline within the first 3 months of radiation therapy. In all comorbidity levels, functional status had not returned to baseline by 6 months. Published by Elsevier Ltd.
Authors: David E Morris; Bahman Emami; Peter M Mauch; Andre A Konski; May L Tao; Andrea K Ng; Eric A Klein; Najeeb Mohideen; Mark D Hurwitz; Bendick A Fraas; Mack Roach; Elizabeth M Gore; Joel E Tepper Journal: Int J Radiat Oncol Biol Phys Date: 2005-05-01 Impact factor: 7.038
Authors: Doris van Abbema; Arnée van Vuuren; Franchette van den Berkmortel; Marjan van den Akker; Laura Deckx; Frank Buntinx; Roel van Kampen; Els Lambooij; Maaike de Boer; Judith de Vos-Geelen; Vivianne C Tjan-Heijnen Journal: J Geriatr Oncol Date: 2017-01-31 Impact factor: 3.599
Authors: Martine T E Puts; Brianne Tapscott; Margaret Fitch; Doris Howell; Johanne Monette; Doreen Wan-Chow-Wah; Monika Krzyzanowska; Nathasha B Leighl; Elena Springall; Shabbir M Alibhai Journal: Cancer Treat Rev Date: 2014-12-26 Impact factor: 12.111
Authors: Emily Finlayson; Shoujun Zhao; W John Boscardin; Brant E Fries; C Seth Landefeld; R Adams Dudley Journal: J Am Geriatr Soc Date: 2012-03-16 Impact factor: 5.562
Authors: Manjula Kurella Tamura; Kenneth E Covinsky; Glenn M Chertow; Kristine Yaffe; C Seth Landefeld; Charles E McCulloch Journal: N Engl J Med Date: 2009-10-15 Impact factor: 91.245
Authors: Joanna-Grace M Manzano; Ruili Luo; Linda S Elting; Marina George; Maria E Suarez-Almazor Journal: J Clin Oncol Date: 2014-10-06 Impact factor: 44.544
Authors: Eni Shehu; Sigrid Roggendorf; André Golla; Antonia Koenig; Gabriele I Stangl; Andrea Diestelhorst; Daniel Medenwald; Dirk Vordermark; Anke Steckelberg; Heike Schmidt Journal: Cancers (Basel) Date: 2022-05-24 Impact factor: 6.575
Authors: Jaidyn Muhandiramge; Suzanne G Orchard; Erica T Warner; Gijsberta J van Londen; John R Zalcberg Journal: Cancers (Basel) Date: 2022-03-08 Impact factor: 6.639