Impact of Physical Inactivity on the Risk of Disability and Hospitalization in Older Patients with Advanced Lung Cancer

Figures & data

Table 1 Baseline Patient Characteristics

	All n=21	Active ^d n=11	Inactive ^e n=10	p-value ^f
Age, median (range)	75 (70–82)	73 (70–81)	76 (72–82)	NS
Gender (Women: Men)	8: 13	6: 5	2: 8	NS
Stage, n (%)				NS
Stage IV	17 (81.0)	9 (81.8)	8 (80.0)
Postoperative recurrence	4 (19.0)	2 (18.2)	2 (20.0)
PS, n (%)				NS
0	7 (33.3)	5(45.5)	2 (20.0)
1	14 (66.7)	6(54.5)	8 (80.0)
Treatment, n (%)				NS
Cytotoxic regimen	15 (71.4)	6 (54.5)	9 (90.0)
Targeted regimen	6 (28.6)	5 (45.5)	1 (10.0)
Never smoke, n (%)	8 (38.1)	5 (45.5)	3 (30.0)	NS
Comorbidities, n (%)				NS
Cardiovascular disease	6 (28.6)	2 (18.2)	4 (40.0)
Cerebrovascular disease	1 (4.8)	1 (9.1)	0 (0.0)
Pulmonary disease	2 (9.5)	2 (18.2)	0 (0.0)
Bone and joint disorder	6 (28.6)	1 (9.1)	5 (50.0)
Type 2 diabetes	5 (23.8)	2 (18.2)	3 (30.0)
Other cancer	2 (9.5)	1 (9.1)	1 (10.0)
BMI (kg/m^2), median (range)	21.9 (19.0–28.1)	21.9 (19.0–28.1)	21.6 (19.2–25.2)	NS
LSMI (cm/m^2), median (range)
Women	36.7 (31.5–46.2)	36.1 (31.5–46.2)	36.7 (36.5–37.0)	NS
Men	43.9 (38.2–50.6)	39.4 (38.2–45.1)	45.2 (39.9–50.6)	< 0.05
Skeletal muscle depletion, n (%) ^a	14 (66.7)	9 (81.8)	5 (50.0)	NS
Cachexia, n (%) ^b	13 (61.9)	6 (54.5)	7 (70.0)	NS
ISWD (m), median (range)
Women	355 (120–480)	355 (120–480)	335 (270–400)	NS
Men	360 (140–550)	340 (270–550)	370 (140–460)	NS
HGS (kg), median (range)
Women	23.7 (19.0–30.3)	21.4 (19.0–26.1)	28.1 (25.9–30.3)	NS
Men	30.6 (25.6–37.2)	29.2 (25.6–37.2)	30.8 (25.8–34.9)	NS
Daily steps, median (range)	3389.6 (1141.6–17,711.3)	3034.4 (1141.6–17,711.3)	4638.8 (1297.6–5824.1)	NS
MVPA ^c (minutes), median (range)	4.4 (0–60.9)	4.3 (1–60.9)	5.2 (0–13.3)	NS

Notes: ^aSkeletal muscle depletion was defined based on LSMI cutoffs of less than 43.0 cm²/m² and 53.0 cm²/m² for men with a BMI of less than 25.0 kg/m² and 25.0 kg/m² or higher, respectively, and the cutoff was 41.0 cm²/m² for women. ^bCancer cachexia was defined as the unintentional weight loss of higher than 5% in the preceding six months, weight loss of higher than 2% in patients with a BMI of less than 20.0 kg/m², or the presence of skeletal muscle depletion. ^cMVPA was defined as physical activity of 3 metabolic equivalents (METs) or more. ^dActive was defined as a patient group with the change rate in daily steps from pretreatment to T2 of −12.5% or higher. ^eInactive was defined as a patient group with the change rate in daily steps from pretreatment to T2 of less than −12.5%. ^fSignificant difference (P < 0.05) tested by Fisher’s exact tests or Wilcoxon rank-sum test.

Abbreviations: PS, eastern cooperative oncology group performance status; BMI, body mass index; LSMI, lumbar skeletal muscle index; ISWD, incremental shuttle walking distance; HGS, hand-grip strength; MVPA, moderate to vigorous physical activity.

Figure 1 Patient flowchart. Flow diagram of patient recruitment and follow-up.

Table 2 Changes in Physical Activity from Pretreatment to T2

	Pretreatment	T2^b
Daily steps, median (range)	3389.6 (1141.6–17,711.3)	3398.6 (345.1–18,847.3)
MVPA ^a (minutes), median (range)	4.4 (0–60.9)	2.3 (0–52.6)

Notes: ^aMVPA was defined as physical activity of 3 metabolic equivalents (METs) or more. ^bT2 was 12 ± 4 weeks from enrolment.

Abbreviation: MVPA, moderate to vigorous physical activity.

Figure 2 Overall and disability-free survival curves. Panel (A) Kaplan-Meier curve of overall survival from T2. Panel (B) Kaplan-Meier curve of disability-free survival from T2. A solid line indicates active patients and a dotted line indicates inactive patients. P-values were calculated using Log rank tests. A disabling event is defined as a decrease in Barthel Index from the pretreatment value by 10 points or higher. The overall and disability-free survival was censored on the final visit for patients whose deaths or disabling events were not confirmed. *T2 was 12 ± 4 weeks from enrolment.

Table 3 Differences in Socioeconomic Parameters of Cancer Treatment in the First Year

Socioeconomic Parameters for the First Year ^a	Active	Inactive	p-value
Cumulative no. of the length of hospital stays ^b	6.3 ± 3.7	23.7 ± 10.1	NS
Cumulative times of hospitalization ^c	0.8 ± 0.5	1.9 ± 0.7	NS
Cumulative no. of unplanned visits or emergency hospitalizations ^c	0.9 ± 0.4	1.7 ± 0.5	NS
Cumulative medical costs ^d
Total	2.5 ± 0.4	3.0 ± 1.0	NS
Outpatient care	2.2 ± 0.3	1.4 ± 0.2	< 0.05
Inpatient care	0.3 ± 0.2	1.6 ± 0.9	NS
Cumulative costs for resource utilization ^d
Chemotherapy	2.0 ± 0.3	0.8 ± 0.3	< 0.05
Radiotherapy/Operation	0.1 ± 0.1	1.4 ± 0.9	NS
Supportive care	0.4 ± 0.2	0.7 ± 0.2	NS

Notes: ^aA mean cumulative function was used for recurrent event analysis of cumulative length of hospital stays and medical costs related to cancer care for the first year from T2. T2 was 12 ± 4 weeks from enrolment. ^bDays per person. ^cTimes per person. ^d × 10⁶ JP yen per person (× 10⁴ US$ per person).

Figure 3 Difference between active and inactive patients in terms of cumulative length of hospital stays and medical costs from T2. Curves of cumulative functions for the length of hospital stays panel (A) and medical costs panel (B) in active patients (solid line) and inactive patients (dotted line). *T2 was 12 ± 4 weeks from enrolment.