Changes in older adults' life space during lung cancer treatment: A mixed methods cohort study

被引:15
作者
Wong, Melisa L. [1 ,2 ,3 ]
Shi, Ying [2 ,3 ]
Smith, Alexander K. [2 ,3 ]
Miaskowski, Christine [4 ,5 ]
Boscardin, W. John [2 ,3 ]
Cohen, Harvey Jay [6 ,7 ]
Lam, Vivian [1 ]
Mazor, Melissa [8 ]
Metzger, Lia [9 ]
Presley, Carolyn J. [10 ]
Williams, Grant R. [11 ,12 ]
Loh, Kah Poh [13 ]
Ursem, Carling J. [1 ,14 ]
Friedlander, Terence W. [1 ,15 ]
Blakely, Collin M. [1 ]
Gubens, Matthew A. [1 ]
Allen, Gregory [1 ]
Shumay, Dianne [16 ]
Walter, Louise C. [2 ,3 ]
机构
[1] Univ Calif San Francisco, Helen Diller Family Comprehens Canc Ctr, Div Hematol Oncol, 550 16th St,Box 3211, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Div Geriatr, San Francisco, CA 94143 USA
[3] San Francisco VA Med Ctr, San Francisco, CA USA
[4] Univ Calif San Francisco, Dept Physiol Nursing, San Francisco, CA 94143 USA
[5] Univ Calif San Francisco, Dept Anesthesiol & Perioperat Care, San Francisco, CA 94143 USA
[6] Duke Univ, Ctr Study Aging & Human Dev, Durham, NC USA
[7] Duke Univ, Duke Canc Inst, Durham, NC USA
[8] Icahn Sch Med Mt Sinai, Div Gen Internal Med, New York, NY 10029 USA
[9] New York Med Coll, Valhalla, NY 10595 USA
[10] Ohio State Univ, Div Med Oncol, Comprehens Canc Ctr, Columbus, OH 43210 USA
[11] Univ Alabama Birmingham, Div Hematol Oncol, Birmingham, AL USA
[12] Univ Alabama Birmingham, Div Gerontol Geriatr & Palliat Care, Birmingham, AL USA
[13] Univ Rochester, Dept Med, Med Ctr, James P Wilmot Canc Inst,Div Hematol Oncol, Rochester, NY USA
[14] San Francisco VA Med Ctr, Div Hematol Oncol, San Francisco, CA USA
[15] Zuckerberg San Francisco Gen, Div Hematol Oncol, San Francisco, CA USA
[16] Univ Calif San Francisco, Helen Diller Family Comprehens Canc Ctr, Dept Psychiat, San Francisco, CA 94143 USA
关键词
cancer treatment; geriatric oncology; life-space mobility; lung cancer; mixed methods; QUALITY-OF-LIFE; MOBILITY; RELIABILITY; VALIDITY; ANXIETY; SCALE;
D O I
10.1111/jgs.17474
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background Maintenance of function during cancer treatment is important to older adults. Characteristics associated with pretreatment life-space mobility and changes during non-small cell lung cancer (NSCLC) treatment remain unknown. Methods This mixed methods cohort study recruited adults age >= 65 with advanced NSCLC starting palliative chemotherapy, immunotherapy, and/or targeted therapy from a Comprehensive Cancer Center, Veterans Affairs, and safety-net clinic. Patients completed geriatric assessments including Life-Space Assessment (LSA) pretreatment and at 1, 2, 4, and 6 months after treatment initiation. LSA scores range from 0 to 120 (greater mobility); LSA <60 is considered restricted. We used mixed-effects models to examine pretreatment LSA, change from 0 to 1 month, and change from 1 to 6 months. A subgroup participated in semistructured interviews pretreatment and at 2 and 6 months to understand the patient experience of life-space change. For each interview participant, we created joint displays of longitudinal LSA scores juxtaposed with illustrative quotes. Results Among 93 patients, median age was 73 (range 65-94). Mean pretreatment LSA score was 67.1. On average, LSA declined 10.1 points from pretreatment to 1 month and remained stable at 6 months. Pretreatment LSA score was associated with several demographic, clinical, geriatric assessment, and symptom characteristics. LSA decline at 1 month was greater among patients with high anxiety (slope = -12.6 vs. -2.3, p = 0.048). Pretreatment body mass index <21 kg/m(2) was associated with LSA improvement from 1 to 6 months (slope = 4.1 vs. -0.04, p = 0.003). Joint displays illustrated the impact of different life-space trajectories on patients' lives in their words. Conclusion Older adults with NSCLC have low pretreatment life space with many developing restricted life space during treatment. Incorporating life-space assessments into clinical cancer care may help older adults concretely visualize how treatment might impact their daily function to allow for informed decision making and identify early changes in mobility to implement supportive interventions.
引用
收藏
页码:136 / 149
页数:14
相关论文
共 50 条
[1]   THE EUROPEAN-ORGANIZATION-FOR-RESEARCH-AND-TREATMENT-OF-CANCER QLQ-C30 - A QUALITY-OF-LIFE INSTRUMENT FOR USE IN INTERNATIONAL CLINICAL-TRIALS IN ONCOLOGY [J].
AARONSON, NK ;
AHMEDZAI, S ;
BERGMAN, B ;
BULLINGER, M ;
CULL, A ;
DUEZ, NJ ;
FILIBERTI, A ;
FLECHTNER, H ;
FLEISHMAN, SB ;
DEHAES, JCJM ;
KAASA, S ;
KLEE, M ;
OSOBA, D ;
RAZAVI, D ;
ROFE, PB ;
SCHRAUB, S ;
SNEEUW, K ;
SULLIVAN, M ;
TAKEDA, F .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 1993, 85 (05) :365-376
[2]  
[Anonymous], 2018, CA Cancer J Clin, DOI DOI 10.3322/caac.20115
[3]   Fear of falling and its association with life-space mobility of older adults: a cross-sectional analysis using data from five international sites [J].
Auais, Mohammad ;
Alvarado, Beatriz ;
Guerra, Ricardo ;
Curcio, Carmen ;
Freeman, Ellen E. ;
Ylli, Alban ;
Guralnik, Jack ;
Deshpande, Nandini .
AGE AND AGEING, 2017, 46 (03) :459-465
[4]   Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies [J].
Batsis, John A. ;
Villareal, Dennis T. .
NATURE REVIEWS ENDOCRINOLOGY, 2018, 14 (09) :513-537
[5]   Age differences in fatigue, decrements in energy, and sleep disturbance in oncology patients receiving chemotherapy [J].
Bischel, Lindsey E. ;
Ritchie, Christine ;
Kober, Kord M. ;
Paul, Steven M. ;
Cooper, Bruce A. ;
Chen, Lee-May ;
Levine, Jon D. ;
Hammer, Marilyn ;
Wright, Fay ;
Miaskowski, Christine .
EUROPEAN JOURNAL OF ONCOLOGY NURSING, 2016, 23 :115-123
[6]   Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging [J].
Correa-de-Araujo, Rosaly ;
Addison, Odessa ;
Miljkovic, Iva ;
Goodpaster, Bret H. ;
Bergman, Bryan C. ;
Clark, Richard, V ;
Elena, Joanne W. ;
Esser, Karyn A. ;
Ferrucci, Luigi ;
Harris-Love, Michael O. ;
Kritchevsky, Steve B. ;
Lorbergs, Amanda ;
Shepherd, John A. ;
Shulman, Gerald, I ;
Rosen, Clifford J. .
FRONTIERS IN PHYSIOLOGY, 2020, 11
[7]  
Creswell J. D., 2014, A Concise Introduction to Mixed Methods Research
[8]  
Edge SB., 2010, AM JOINT COMMITTEE C
[9]   THE DEVELOPMENT, VALIDITY, AND RELIABILITY OF THE OARS MULTIDIMENSIONAL FUNCTIONAL ASSESSMENT QUESTIONNAIRE [J].
FILLENBAUM, GG ;
SMYER, MA .
JOURNALS OF GERONTOLOGY, 1981, 36 (04) :428-434
[10]   Understanding the treatment preferences of seriously ill patients [J].
Fried, TR ;
Bradley, EH ;
Towle, VR ;
Allore, H .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (14) :1061-1066