BACKGROUND AND OBJECTIVES:Using an instrument to measure physical functioning that was normed to the U.S. population, data were obtained from patients with a new diagnosis of breast, colon, lung, and prostate cancer. Two questions were addressed: (a) after controlling for age, and number of comorbid conditions, do site and stage of cancer predict functional limitations prior to diagnosis; (b) using age adjusted national norms on physical functioning, how well do age, number of comorbid conditions, stage, treatment and cluster of symptoms (pain, fatigue, and insomnia) explain changes in physical 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 initial treatment. The SF-36 was used to measure physical functioning. Comorbidity 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 for variations in physical functioning prior to diagnosis. Compared against national norms, patients with more extensive treatments (surgery plus adjuvant therapy) reported greater loss in functioning. Pain, fatigue, and insomnia had a consistent and significant effect on losses in functioning unrelated to patients' treatments or their comorbid conditions. CONCLUSIONS:Site and stage of cancer prior to diagnosis do not affect functioning. Older cancer patients report higher functioning than their counterparts in the U.S. population. Changes in functioning following diagnosis varied by cancer site. Treatments were related to loss in functioning, but comorbidity was not. Pain, fatigue, and insomnia were significant and independent predictors of change in patient functioning. This underscores the importance of interventions to manage symptoms early in the course of treatment for individuals.

译文

背景与目的:使用一种针对美国人群的生理功能测量仪器,从乳腺癌,结肠癌,肺癌和前列腺癌的新诊断患者中获取数据。解决了两个问题:(a)在控制了年龄和合并症的数量之后,癌症的部位和阶段是否可以在诊断之前预测功能限制? (b)使用经过年龄调整的身体机能国家规范,年龄,合并症数,阶段,治疗和症状(疼痛,疲劳和失眠)的状况如何,可以解释在3个月前和8周之间身体机能的变化以下诊断?
方法:来自24个社区肿瘤科的患者年龄在65岁及以上。同意患者在初次治疗后8周内接受采访。 SF-36用于测量身体机能。通过患者报告以及记录审核的癌症部位和阶段来评估合并症和症状经验。
结果:在诊断出癌症之前,患者的身体功能与美国55-64岁的人群相当,比癌症患者的年龄年轻了整整十年。疾病的部位和阶段并未解释诊断前身体机能的变化。与国家标准相比,接受更广泛治疗(手术加辅助治疗)的患者报告功能丧失更大。疼痛,疲劳和失眠对与患者的治疗或合并症无关的功能丧失具有持续而显着的影响。
结论:诊断前的部位和癌症分期不影响功能。较年长的癌症患者报告说其功能比美国人群中的同行患者更高。诊断后功能的变化因癌症部位而异。治疗与功能丧失有关,但合并症无关。疼痛,疲劳和失眠是患者功能变化的重要且独立的预测因子。这强调了在个体治疗过程中早期管理症状的干预措施的重要性。

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