Physical Performance Limitations and Participation Restrictions Among Cancer Survivors: A Population-Based Study
Introduction
Steady progress in the effectiveness of treatment for cancer over the past several decades has led to an increase in the population of cancer survivors and to an increasing interest in the long-term consequences of cancer and its treatment (1). Estimates from the National Cancer Institute (2) indicate that of the 1,334,100 persons with a newly diagnosed cancer each year, over 60% will go on to become a 5-year survivor (3). Over 9 million persons in the US who are alive today have or have had a diagnosis of cancer (2). Although continuing efforts to cure cancer are paramount, treatment progress necessitates a focused effort to improve our understanding of the morbidity that is a byproduct of cancer survivorship.
Cancer survivors potentially have medical and psychosocial late effects as a result of damage from both the malignancy and from the treatments used to eliminate the malignancy. Invasive surgery, powerful chemotherapy, and high doses of therapeutic radiation necessary to impart a cure have the potential to result in long-term impairments of organ system function, which in turn may limit physical performance and ultimately result in the inability to carry out routine activities as part of daily life (Fig. 1).
Physical performance is a construct of the activity component of function classified by the World Health Organization (WHO) in the International Classification of Functioning, Disability, and Health (ICF), and is defined as the “ability to perform a physical action, task or activity in an efficient, typically expected or competent manner” 4, 5. Function may become limited when impairments of particular body systems restrict the person's ability to carry out a task. Participation in daily tasks is defined as the “ability to perform actions, tasks, and activities related to self-care, home management, work, community, and leisure roles in both socio-cultural and environmental contexts” (4). The inability to fully participate was typically referred to by the WHO as a handicap. This term, however, was replaced with “participation restriction” in the most recent version of the ICF (5).
The aims of this analysis were to estimate the proportion of physical performance limitations and difficulty with routine activities in the home or community (participation restrictions) among individuals ≥ 20 years old or older who had a history of cancer, and to compare these proportions among recent cancer survivors (< 5 years since diagnosis) and long-term cancer survivors (≥ 5 since diagnosis) to the proportions of physical performance limitations and performance restrictions in the general adult population.
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Methods
Data for this analysis were derived from the National Health and Nutrition Examination Survey (NHANES 1999–2002), a population-based survey using a complex multistage sampling design to collect health and nutrition information on the noninstitutionalized United States (US) population who are aged 2 months and older. NHANES is now conducted yearly; the 1999–2002 data is the first 4-year portion of the eighth series 6, 7, 8. We limited our analysis to individuals age 20 years of age or older at
Study Participants
The NHANES 1999–2002 public use dataset included 21,004 individuals who completed the in home interview. Our analysis included 10,083 adults; excluded from the analysis were 10,713 children, 15 individuals who did not answer the question “Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind?” and 193 individuals who reported their first primary cancer as nonmelanoma skin cancer.
A positive cancer history was reported by 8.7% of the
Discussion
This analysis demonstrates (1) the increased risk of functional loss and participation restrictions soon after the acute phase of cancer diagnosis and treatment, and (2) the potential for either persistent or new onset functional loss and participation restrictions many years following treatment. Participants in this study with either an acute or long-term cancer history were 1.5–1.8 times more likely than were study participants with no cancer history to report physical performance limitations
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