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J Geriatr Oncol. 2019 Jan;10(1):60-67. doi: 10.1016/j.jgo.2018.05.017. Epub 2018 Jun 22.

Functional trajectories before and after a new cancer diagnosis among community-dwelling older adults.

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The Ohio State University, Medical Oncology (For correspondence and reprints), B424 Starling Loving Hall 320 W, 10th Avenue, Columbus, OH 43214, USA. Electronic address:
Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA.
City of Hope Comprehensive Cancer Center, Medical Oncology Duarte, CA, USA.



To characterize functional trajectories in the year before and after a new cancer diagnosis among older adults and to identify risk factors for worsening disability post-diagnosis.


We identified 170 participants 70+ years with monthly assessments of thirteen basic, instrumental, and mobility activities and with a new cancer diagnosis from 1998 to 2014. A group-based trajectory model identified distinct functional trajectories based on a total disability score during the twelve months pre- and post-diagnosis. We evaluated associations between potential risk factors at the time of cancer diagnosis and worsening disability post-diagnosis, explored functional transitions from pre- to post-diagnosis and identified participants whose functional trajectories worsened.


Three pre-diagnosis functional trajectories were identified among 170 participants (mean age at diagnosis: 83 years (range: 73-105 years): mild, moderate, and severe disability. Three post-diagnosis functional trajectories were identified among 158 non-decedents: mild, moderate, and severe disability. Most participants (93.9%) with severe disability pre-diagnosis had severe disability post-diagnosis. Risk factors independently associated with worsening disability post-diagnosis included moderate or severe disability pre-diagnosis (adjusted risk ratio, aRR: moderate: 2.96; 95%CI: 2.11-4.16; severe: 5.11; 95%CI: 3.07-8.52) vs. mild (reference), poor physical capability (aRR: 1.57; 95%CI: 1.07-2.30), and incurable stage (aRR:1.99; 95%CI: 1.41-2.80). 40% of participants with a mild or moderate disability trajectory pre-diagnosis transitioned to a worse functional trajectory post-diagnosis.


Older adults followed distinct functional trajectories in the twelve months before and after cancer diagnosis. Functional trajectory pre-diagnosis, poor physical capability, and incurable stage were independent risk factors for worsening disability post-diagnosis.


Activities of daily living; Disability; Driving; Functional status; Independent activities of daily living; Mobility; Risk factors

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