Objective Measurements of Physical Function to Predict Survival in Patients with Metastatic Cancer

Abstract

Background/Objectives

Physician-reported performance status (PS) constitutes the established method for stratifying oncologic patients in therapeutic decision-making. Objective measurements of physical function may further refine prognostication.

Subjects/Methods

In this prospective observational study, 103 patients with metastatic cancer who were referred for systemic therapy initiation were evaluated. PS was evaluated using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and five objective physical function measurements (handgrip strength [HGS], chair stand test [CST], timed up and go [TUG] test, 4-m gait speed [GS] test, and short physical performance battery [SPPB] test). Overall survival and treatment complications were recorded from the medical records.

Results

Patients with low PS according to ECOG-PS (hazard ratio [HR]: 3.80, 95% confidence interval [CI]: 1.84, 7.80), HGS (HR: 2.37, 95% CI: 1.24, 4.55), SPPB (HR: 3.43, 95% CI: 1.55, 7.57), GS (HR: 3.03, 95% CI: 1.44, 6.38), and TUG (HR: 5.16, 95% CI: 2.19, 12.14) had shorter overall survival after adjustment for sex, age, symptomatology, comorbidity, percentage of weight loss, and tumor localization.

Conclusions

Among the studied objective physical function measurements, HGS, SPPB, GS, and TUG were independent predictors of survival in a sample of patients with metastatic cancer, with TUG showing the highest effect size.

Acknowledgments

We would like to thank Theofano Samarina, Eleni Lianou, Afroditi Letsiou, Stella Dragganoudi, Theodora Befa and Ioannis Papachristou, the nurses and paramedical staff that helped to this research.

Author Contribution Statement

M.D.K. and I.G. contributed to the conception and design of the study and supervised the data analyses; A.K. and M.S. contributed to study design; I.M., I.G., A.M. and E.A. contributed to data acquisition and analyses; I.M., drafted the manuscript. All authors have critically revised the manuscript, gave final approval and agreed to be fully accountable for ensuring the integrity and accuracy of the work, and have read and approved the final manuscript.

Data Availability

Dataset can be available on request from supervisor of the project (M.D.K.). Requests to access these datasets should be directed to [email protected].

Disclosure Statement

The authors declare no conflict of interest regarding the design and conduct of the present study.

Ethical Approval

The protocol was approved by the Ethics and Scientific Committee of the University of Thessaly and it was conducted in accordance with the Declaration of Helsinki.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.