Article

To outline the potential reasons for the persistent underutilization of
rehabilitation services in the care of patients with advanced cancer, a
literature review and post hoc analysis of data collected from 163 patients with
stage IV breast cancer are used to examine the role of accumulated physical
impairments and adverse symptoms in cancer-related disablement. Univariate and
multivariate regression analyses were used to estimate the variance in functional
outcomes (as measured by the Physical Function-10, Functional Independence
Measure, and the Older Americans Resource Study subscales) explained by the
presence and interaction of physical impairments, pain (Brief Pain Inventory
scores), and exertional limitations (6-min walk test performance). A majority of
patients had more than three impairments. Potentially catastrophic impairments,
for example, paraparesis and hemiparesis, occurred in only 15% of patients.
Although most specific impairments explained less than 5% of the variance in
functional outcomes, a participant's total number of impairments was strongly
correlated with his/her performance status and explained between 36% and 52% of
the variance in functional outcomes. Brief Pain Inventory scores and exertional
intolerance explained a greater proportion of the variance in functional outcomes
than did the presence of impairments. Multivariate models using total number of
impairments, Brief Pain Inventory scores, exertional intolerance, and their
interactions accounted for up to 65% of the variance in functional outcomes. The
disablement process in metastatic breast cancer is driven by the accrual of
multiple physical impairments, adverse symptoms, and their interactions rather
than by discrete and functionally catastrophic impairments. Without systematic
disability screening, the detection of functional decline may remain challenging.

Langue : ANGLAIS