A new survey shows that 40.2% of hospitalized patients with advanced, incurable cancer were functionally impaired at the time they were admitted, meaning they needed help with activities of daily living (ADLs), such as walking, bathing, or getting dressed.1

Investigators at Mass General Cancer Center studied 970 patients aged 18 years and older with advanced cancer, defined as cancers not being treated with curative intent. They used nursing documentation collected at intake to evaluate functional impairment and collected self-completed questionnaires from the patients. ADL impairment was defined as any need for assistance by another person.1

In total, 40.2% (390) of the patients had at least 1 ADL impairment, 14.8% had 1 or 2 impairments, and 25.4% experienced at least 3 areas of difficulty with daily tasks.1 Specifically, 37.7% had impaired mobility, 25.9% had difficulty bathing, 24% needed assistance dressing, 22.1% reported impaired grooming, and 11% reported impaired feeding.1

“Oncologists have long appreciated that functional status is a powerful predictor of a number of important outcomes, including survival and treatment outcomes,” said Toby Campbell, MD, chief of palliative care at the University of Wisconsin Carbone Cancer Center, in a statement. “We know that the routine assessment of symptom burden and functional status in the outpatient setting results in improved survival and quality of life.”2

Notably, patients with ADL impairments had higher rates of pain, depression, and anxiety, and were more likely to have longer hospital stays and worse survival.1 For example, of patients with no ADL impairment, 23.6% reported depression, compared with 38.3% of patients with at least 1 ADL impairment. Similarly, 22.4% of patients with no ADL impairments reported anxiety, compared with 35.9% of patients with ADL impairments.1

The investigators noted that in the general medicine population, interventions such as exercise programs and discharge planning efforts have been promising in addressing functional impairment and improving post-discharge outcomes. Other options could include tele-rehabilitation and alternatives to hospitalization, such as hospital-at-home interventions, according to the authors.1

Collecting information about patients’ ADLs at the time of admission could be extremely helpful, the authors added, and could be used to guide discussions with patients, address functional impairments, and plan for transitions of care.1

“Interventions addressing patients’ functional impairment and symptom management could help enhance care delivery and outcomes for the highly symptomatic population of hospitalized patients with advanced cancer,” said lead researcher Daniel E. Lage, MD, MsC, in a statement. “This highlights the need for efforts to integrate functional assessments into the care of these patients to identify individuals who may benefit from physical therapy, palliative care, and other supportive services earlier in their hospital stay.”2

REFERENCES
  1. Lage D, El-Jawahri A, Fuh C, et al. Functional Impairment, Symptom Burden, and Clinical Outcomes Among Hospitalized Patients with Advanced Cancer. JNCCN; June 2020. https://jnccn.org/view/journals/jnccn/18/6/article-p747.xml. Accessed June 8, 2020.
  2. JNCCN: Many Hospitalized People with Advanced Cancer Struggle with Important Daily Tasks [news release]. National Comprehensive Cancer Network; June 8, 2020. https://www.nccn.org/about/news/newsinfo.aspx?NewsID=2147. Accessed June 8, 2020.