Background: For older patients with cancer, maintaining or regaining their ability to care of themselves is of major interest. Which tools are appropriate to measure this? Different tools to assess functional status (FS) are established in geriatric and oncological care, but they have been compared poorly in the past. Patients and Methods: Within a prospective cohort trial, we included 483 patients: 198 older patients with cancer, 156 younger patients with cancer, and 129 older patients with benign disease. FS was assessed as Eastern Cooperative Oncology Group performance status (ECOG-PS), activities of daily living (ADL), and instrumental activities of daily living (IADL). Results were compared for their differences in identifying patients as functionally compromised. Summary: The relative frequency of cancer patients with limitations in ECOG-PS, ADL, and IADL, respectively, increased from 25.7, 13.5, and 17.9% in those <60 years of age to 50.0, 47.1, and 66.7% in those ≥80 years. Results in older patients with cancer were comparable to older patients with benign disease. In older patients with cancer, 20.7 and 21.6% with a good ECOG-PS had limitations in ADL and IADL, respectively; of those without limitations in ADL and IADL, 34.7 and 26.0%, respectively, had a poor ECOG-PS. Treatment approach (curative vs. palliative) was found to be significantly associated with functional limitations. Key Messages: Geriatric and oncological measure of FS report differences in functional impairment. Geriatric functional measures are more sensitive to age-related changes and should be included as patient-reported outcomes in clinical trials and care.

1.
Siegel
RL
,
Miller
KD
,
Jemal
A
.
Cancer statistics, 2019
.
CA Cancer J Clin
.
2019
Jan
;
69
(
1
):
7
34
.
[PubMed]
0007-9235
2.
Lamont
EB
,
Schilsky
RL
,
He
Y
,
Muss
H
,
Cohen
HJ
,
Hurria
A
, et al;
Alliance for Clinical Trials in Oncology
.
Generalizability of trial results to elderly Medicare patients with advanced solid tumors (Alliance 70802)
.
J Natl Cancer Inst
.
2014
Nov
;
107
(
1
):
336
.
[PubMed]
1460-2105
3.
Ludmir
EB
,
Mainwaring
W
,
Lin
TA
,
Miller
AB
,
Jethanandani
A
,
Espinoza
AF
, et al
.
Factors Associated With Age Disparities Among Cancer Clinical Trial Participants
.
JAMA Oncol
.
2019
Jun
;
5
(
12
):
1769
.
[PubMed]
2374-2437
4.
Wildiers
H
,
Heeren
P
,
Puts
M
,
Topinkova
E
,
Janssen-Heijnen
ML
,
Extermann
M
, et al
.
International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer
.
J Clin Oncol
.
2014
Aug
;
32
(
24
):
2595
603
.
[PubMed]
0732-183X
5.
Ellis
G
,
Whitehead
MA
,
O’Neill
D
,
Langhorne
P
,
Robinson
D
.
Comprehensive geriatric assessment for older adults admitted to hospital
.
Cochrane Database Syst Rev
.
2011
Jul
;(
7
):
CD006211
.
[PubMed]
1469-493X
6.
Baumann
R
,
Pütz
C
,
Röhrig
B
,
Höffken
K
,
Wedding
U
.
Health-related quality of life in elderly cancer patients, elderly non-cancer patients and an elderly general population
.
Eur J Cancer Care (Engl)
.
2009
Sep
;
18
(
5
):
457
65
.
[PubMed]
0961-5423
7.
Oken
MM
,
Creech
RH
,
Tormey
DC
,
Horton
J
,
Davis
TE
,
McFadden
ET
, et al
.
Toxicity and response criteria of the Eastern Cooperative Oncology Group
.
Am J Clin Oncol
.
1982
Dec
;
5
(
6
):
649
55
.
[PubMed]
0277-3732
8.
Karnofsky
DA
,
Burchenal
JH
.
The clinical evaluation of chemotherapeutic agent in the treatment of neoplastic disease. Evaluation of Chemotherapeutic Agents. C. M. MacLeod
.
New York
:
Columbia University Perss
;
1949
.
9.
Karnofsky
DA
,
Abelmann
WH
,
Burchenal
CL
.
The use of the nitrogen mustards in th palliative treatment of carcinoma
.
Cancer
.
1948
Nov
;
1
(
4
):
634
56
. 0008-543X
10.
Péus
D
,
Newcomb
N
,
Hofer
S
.
Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation
.
BMC Med Inform Decis Mak
.
2013
Jul
;
13
(
1
):
72
.
[PubMed]
1472-6947
11.
Katz
S
,
Ford
AB
,
Moskowitz
RW
,
Jackson
BA
,
Jaffe
MW
.
Studies of Illness in the Aged. The Index of ADL: A Standardized Measure of Biological and Psychosocial Function
.
JAMA
.
1963
Sep
;
185
(
12
):
914
9
.
[PubMed]
0098-7484
12.
Mahoney
FI
,
Barthel
DW
.
Functional evaluation: The Barthel Index
.
Md State Med J
.
1965
Feb
;
14
:
61
5
.
[PubMed]
0025-4363
13.
Lawton
MP
,
Brody
EM
.
Assessment of older people: self-maintaining and instrumental activities of daily living
.
Gerontologist
.
1969
;
9
(
3
):
179
86
.
[PubMed]
0016-9013
14.
Buccheri
G
,
Ferrigno
D
,
Tamburini
M
.
Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution
.
Eur J Cancer
.
1996
Jun
;
32A
(
7
):
1135
41
.
[PubMed]
0959-8049
15.
Wedding
U
,
Röhrig
B
,
Klippstein
A
,
Brix
C
,
Pientka
L
,
Höffken
K
.
Co-morbidity and functional deficits independently contribute to quality of life before chemotherapy in elderly cancer patients
.
Support Care Cancer
.
2007
Sep
;
15
(
9
):
1097
104
.
[PubMed]
0941-4355
16.
Wedding
U
,
Pientka
L
,
Höffken
K
.
Quality-of-life in elderly patients with cancer: a short review
.
Eur J Cancer
.
2007
Oct
;
43
(
15
):
2203
10
.
[PubMed]
0959-8049
17.
Wildiers
H
,
Mauer
M
,
Pallis
A
,
Hurria
A
,
Mohile
SG
,
Luciani
A
, et al
.
End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer—Alliance for Clinical Trials in Oncology—International Society Of Geriatric Oncology position article
.
J Clin Oncol
.
2013
Oct
;
31
(
29
):
3711
8
.
[PubMed]
0732-183X
18.
Parmelee
PA
,
Thuras
PD
,
Katz
IR
,
Lawton
MP
.
Validation of the Cumulative Illness Rating Scale in a geriatric residential population
.
J Am Geriatr Soc
.
1995
Feb
;
43
(
2
):
130
7
.
[PubMed]
0002-8614
19.
Lübke
N
,
Meinck
M
,
Von Renteln-Kruse
W
.
[The Barthel Index in geriatrics. A context analysis for the Hamburg Classification Manual]
.
Z Gerontol Geriatr
.
2004
Aug
;
37
(
4
):
316
26
.
[PubMed]
0948-6704
20.
Mohile
SG
,
Dale
W
,
Somerfield
MR
,
Schonberg
MA
,
Boyd
CM
,
Burhenn
PS
, et al
.
Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology
.
J Clin Oncol
.
2018
Aug
;
36
(
22
):
2326
47
.
[PubMed]
0732-183X
21.
Stafford
RS
,
Cyr
PL
.
The impact of cancer on the physical function of the elderly and their utilization of health care
.
Cancer
.
1997
Nov
;
80
(
10
):
1973
80
.
[PubMed]
0008-543X
22.
Fratino
L
,
Serraino
D
,
Zagonel
V
.
The impact of cancer on the physical function of the elderly and their utilization of health care. G.I.O. Ger (Gruppo Italiano Oncologia Geriatrica)
.
Cancer
.
1998
Aug
;
83
(
3
):
589
91
.
[PubMed]
0008-543X
23.
Repetto
L
,
Fratino
L
,
Audisio
RA
,
Venturino
A
,
Gianni
W
,
Vercelli
M
, et al
.
Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study
.
J Clin Oncol
.
2002
Jan
;
20
(
2
):
494
502
.
[PubMed]
0732-183X
24.
Serraino
D
,
Fratino
L
,
Zagonel
V
,
Group
GI
;
GIOGer Study Group (Italy)
.
Prevalence of functional disability among elderly patients with cancer
.
Crit Rev Oncol Hematol
.
2001
Sep
;
39
(
3
):
269
73
.
[PubMed]
1040-8428
25.
Winkelmann
N
,
Petersen
I
,
Kiehntopf
M
,
Fricke
HJ
,
Hochhaus
A
,
Wedding
U
.
Results of comprehensive geriatric assessment effect survival in patients with malignant lymphoma
.
J Cancer Res Clin Oncol
.
2011
Apr
;
137
(
4
):
733
8
.
[PubMed]
0171-5216
26.
Kikuchi
R
,
Broadwater
G
,
Shelby
R
,
Robertson
J
,
Zullig
LL
,
Maloney
B
, et al
.
Detecting geriatric needs in older patients with breast cancer through use of a brief geriatric screening tool
.
J Geriatr Oncol
.
2019
Nov
;
10
(
6
):
968
72
.
[PubMed]
1879-4068
27.
Kenis
C
,
Decoster
L
,
Van Puyvelde
K
,
De Grève
J
,
Conings
G
,
Milisen
K
, et al
.
Performance of two geriatric screening tools in older patients with cancer
.
J Clin Oncol
.
2014
Jan
;
32
(
1
):
19
26
.
[PubMed]
0732-183X
28.
Deschler
B
,
Ihorst
G
,
Hüll
M
,
Baier
P
.
Regeneration of older patients after oncologic surgery. A temporal trajectory of geriatric assessment and quality of life parameters
.
J Geriatr Oncol
.
2019
Jan
;
10
(
1
):
112
9
.
[PubMed]
1879-4068
29.
Kirkhus
L
,
Harneshaug
M
,
Šaltytė Benth
J
,
Grønberg
BH
,
Rostoft
S
,
Bergh
S
, et al
.
Modifiable factors affecting older patients’ quality of life and physical function during cancer treatment
.
J Geriatr Oncol
.
2019
Nov
;
10
(
6
):
904
12
.
[PubMed]
1879-4068
You do not currently have access to this content.