Patient-Reported Ability to Walk 4 m and to Wash: New Clinical Endpoints and Predictors of Survival in Patients With Pre-terminal Cancer

Authors

Markus S Anker
Alessia Lena
Eric J Roeland
Jan Porthun
Sebastian Schmitz
Sara Hadzibegovic
Philipp Sikorski
Ursula Wilkenshoff
Ann-Kathrin Fröhlich
Luisa Valentina Ramer
Matthias Rose
Jan Eucker
Tienush Rassaf
Matthias Totzeck
Lorenz H Lehmann
Stephan von Haehling
Andrew J S Coats
Tim Friede
Javed Butler
Stefan D Anker
Hanno Riess
Ulf Landmesser
Lars Bullinger
Ulrich Keller
Johann Ahn

Language

English

Publication Date

8-1-2023

Journal

Journal of Cachexia, Sarcopenia and Muscle

DOI

10.1002/jcsm.13247

PMID

37222009

PMCID

PMC10401535

PubMedCentral® Posted Date

5-24-2023

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Maintaining the ability to perform self-care is a critical goal in patients with cancer. We assessed whether the patient-reported ability to walk 4 m and wash oneself predict survival in patients with pre-terminal cancer.

Methods: We performed a prospective observational study on 169 consecutive hospitalized patients with cancer (52% female, 64 ± 12 years) and an estimated 1-12 months prognosis at an academic, inpatient palliative care unit. Patients answered functional questions for 'today', 'last week', and 'last month', performed patient-reported outcomes (PROs), and physical function assessments.

Results: Ninety-two (54%) patients reported the ability to independently walk 4 m and 100 (59%) to wash 'today'. The median number of days patients reported the ability to walk 4 m and wash were 6 (IQR 0-7) and 7 (0-7) days ('last week'); and 27 (5-30) and 26 (10-30) days ('last month'). In the last week, 32% of patients were unable to walk 4 m on every day and 10% could walk on 1-3 days; 30% were unable to wash on every day and 10% could wash on 1-3 days. In the last months, 14% of patients were unable to walk 4 m on every day and 10% could only walk on 1-10 days; 12% were unable to wash on every day and 11% could wash on 1-10 days. In patients who could walk 'today' average 4 m gait speed was 0.78 ± 0.28 m/s. Patients who reported impaired walking and washing experienced more symptoms (dyspnoea, exertion, and oedema) and decreased physical function (higher Eastern Cooperative Oncology Group Performance Status, and lower Karnofsky Performance Status and hand-grip strength [unable vs. able to walk 'today': 205 ± 87 vs. 252 ± 78 Newton, P = 0.001; unable vs. able to wash 'today': 204 ± 86 vs. 250 ± 80 Newton, P = 0.001]). During the 27 months of observation, 152 (90%) patients died (median survival 46 days). In multivariable Cox proportional hazards regression analyses, all tested parameters were independent predictors of survival: walking 4 m 'today' (HR 0.63, P = 0.015), 'last week' (per 1 day: HR 0.93, P = 0.011), 'last month' (per 1 day: HR 0.98, P = 0.012), 4 m gait speed (per 1 m/s: HR 0.45, P = 0.002), and washing 'today' (HR 0.67, P = 0.024), 'last week (per 1 day HR 0.94, p=0.019), and 'last month' (per 1 day HR 0.99, P = 0.040). Patients unable to walk and wash experienced the shortest survival and most reduced functional status.

Conclusions: In patients with pre-terminal cancer, the self-reported ability to walk 4 m and wash were independent predictors of survival and associated with decreased functional status.

Keywords

Humans, Female, Male, Walking, Prospective Studies, Walking Speed, Regression Analysis, Hand Strength, Neoplasms, Self‐care, Palliative care, Walking ability, Washing ability, Cancer, Independence

Published Open-Access

yes

Recommended Citation

Anker, Markus S; Lena, Alessia; Roeland, Eric J; et al., "Patient-Reported Ability to Walk 4 m and to Wash: New Clinical Endpoints and Predictors of Survival in Patients With Pre-terminal Cancer" (2023). Staff and Researcher Publications. 90.
https://digitalcommons.library.tmc.edu/clinic_pub/90