Risk of significant functional impairment across cancer diagnosis and care continuum.
Authors: Flores Ann Marie , Shah Mitisha , Bedjeti Katy , Franklin Patricia D. , Peipert John Devin , Garcia Sofia F. , Lancki Nicola , Webster Kimberly A. , O'Connor Mary Lillian , Cella David 
Published: June 2024

11100

Background: The purpose of this paper is to examine the extent of unmet need to address physical and functional (PF) impairment among ambulatory cancer patients who were screened at baseline for PF impairment in the NCI Cancer Moonshot study - Northwestern University Improving the Management of Symptoms during and Following Cancer Treatment (NU IMPACT). We hypothesized that PF impairment, measured using the Patient Reported Outcome Measurement Information System – Physical Function (PROMIS-PF), would be common overall, and more prevalent for patients receiving active treatment (intent to cure or palliative) as compared to those in the post-treatment survivorship phase. We also hypothesized that PF impairment would differ across tumor types, independent of cancer continuum phase. Methods: The sample consisted of adults diagnosed with cancer, enrolled and consented in NU IMPACT (n=2,273). We compared PROMIS-PF scores across phases of the cancer continuum. Cancer continuum status was defined by the electronic health record (Epic) Beacon module that classifies patients as receiving active cancer treatment (intent to cure or palliative). Patients not assigned a Beacon status were classified as being in the survivorship group. Tumor type was derived from tumor registry data. A PF score less than or equal to 40 was categorized as moderate-to-severe impairment. We used multivariable logistic regression models to evaluate our hypotheses with a 95% confidence interval. Results: Overall, 40% of patients reported moderate-to-severe PF impairment. Patients diagnosed with melanoma reported the least impairment; those with lung cancer were 6.5 times more likely to have moderate-to-severe PF impairment (95% CI: 2.39 - 17.77). Those in non-curative intent treatment were 1.5 times more likely to have PF impairment (95% CI: 1.05 - 2.15) with lower mean PF scores (mean = 43; p<.001) as compared to those in curative intent (mean=46) and survivorship (mean=48). One-third of those reporting PF impairment also reported moderate-to-severe levels of pain and/or fatigue. Conclusions: PF impairment is present for a large minority of our cohort. Except for patients with lung cancer, PF impairment varied little by tumor type suggesting unmet need across the board. Those in non-curative treatment had more PF impairment than those in post-treatment survivorship providing guidance for targeted and early intervention by cancer rehabilitation. There appears to be a clustering of symptoms that affect human movement. Regular monitoring for PF impairments – in addition to pain and fatigue - may fill a gap in care that should be addressed with appropriate cancer rehabilitation referral and intervention. PROMIS-PF effectively identified variation in physical function. Future studies will explore how timely detection of PF impairment can be used to refer patients for appropriate cancer rehabilitation services and utilization.