Cancer Survivors Who Experience Functional Limitations Have Doubled in Past 20 Years

Approximately 70% of cancer survivors have reported at lease 1 type of functional limitation, according to the results of a collaborative study published in JAMA Oncology and conducted by researchers at Johns Hopkins Kimmel Cancer Center, the Dell Medical School in Austin, Texas, and the University of Minnesota’s Masonic Cancer Center in Minneapolis. This rate of functional limitations is twice as high as rates in the general population.¹

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“The fact that we are saving more lives from cancer is worth celebrating, but it also warrants a shift toward understanding and improving the quality of life for those who survive,” said study co-author SM Qasim Hussaini, MD, MS, chief medical oncology fellow and a health systems researcher at the Kimmel Cancer Center, in a press release.

The population of cancer survivors have grown since the early 2000s, but research is limited about the quality of life (QoL) among this patient population. One of the key determinants of QoL is functional ability, defined by the National Institutes of Health as the ability to perform activities of daily living independently without undue pain and fatigue.²

In the past 20 years, reports of limitations in daily functional ability have more than doubled among cancer survivors, explained study author Vishal Patel, a medical student at the Dell Medical School, in the press release. There may be 8 million survivors experiencing functional limitations, Patel added.

Patel and Arjun Gupta, MD, a medical oncologist, and supportive care expert at the University of Minnesota, led a recent study to investigate how increasing survivorship is associated with functional ability.¹

Investigators reviewed 20 years of data from 1999 to 2018 and collected the annual National Health Interview Survey administered by the Centers for Disease Control and Prevention. The team focused on the relationship between survivors of cancer (women 60.2%; 55.4% aged 65 years and older) and experiencing 12 functional limitations (i.e., difficulty sitting for 2 hours or more; difficulty participating in social activities without assistance).

Investigators discovered that 70% of survivors had at least 1 functional limitation. Functional limitations were found to disproportionately affect Hispanic and Black survivors of cancer as well, which may suggest that they have worse quality of survivorship care.

Based on the results of the study, Hussaini recommends:

• Increasing efforts to ensure cancer survivors can access high quality survivorship care.
• That clinicians be more readily able to identify and address cancer burdens.
• At the patient level, investigating the causes of functional limitations.
• At the institutional level, making functional status a key endpoint in clinical trials to create novel therapies.

“The findings are concerning societally and clinically,” said Hussaini in the press release. “Further efforts at the health systems level may consider how survivorship care could be redesigned with better provider training and reimbursement structure.”

References

1. Johns Hopkins Medicine. Study finds functional limitations increasing in survivors of cancer. News Release. June 7, 2023. Accessed June 8, 2023. https://www.eurekalert.org/news-releases/991783
2. Ramnath U, Raunch L, Lambert EV, et al. The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study. PLoS One. 2018; 13(4): e0194918. doi: 10.1371/journal.pone.0194918