Prevalence of functional impairments in older, community-dwelling adults with and without a history of cancer: Analysis of wave 1 of the Irish longitudinal study on ageing (TILDA)

INTRODUCTION: Improvements in cancer survival are happening in the context of an ageing population who may experience age-related complications from cancer therapies and unique needs in cancer survivorship. The long-term survivorship trajectory in terms of function, participation and associated health indicators is poorly documented outside of the United States (U.S.). The overall aim of this study is to examine perceived physical performance limitations, participation restrictions and associated objective metrics among an Irish cohort of cancer survivors aged >50 years. MATERIALS AND METHODS: A sub-cohort of data from Wave 1 of The Irish Longitudinal Study of Ageing (TILDA) (collected October 2009-February 2011) were analysed. Self-reported physical performance and participation restrictions, and related objective measures (timed-up-and-go, handgrip strength, dual manual task, gait speed, heel ultrasound T-scores and heel ultrasound stiffness index), were examined in those diagnosed with cancer <5 years ago (n = 157), >5 years ago (n = 208) and those without a history of cancer (n = 5526). Data were analysed using multivariate regression models using appropriate survey weights to reflect population estimates. RESULTS: Recent cancer survivors were 1.81 (95% CI: 1.08, 3.06) times more likely to report at least one physical performance limitation than individuals without a history of cancer. Furthermore, long-term survivors exhibited a higher risk of severe cumulative physical performance limitations (OR = 3.05, 95% CI: 1.31, 7.12) compared to individuals without a history of cancer. In multivariate analysis, osteoporosis risk was twice as high in long-term cancer survivors as assessed by both heel ultrasound T-scores (RRR 2.26 (95% CI: 1.29, 3.94)) and heel ultrasound stiffness index (RRR 2.21 (95% CI: 1.20, 4.08) compared to individuals without a history of cancer. Objective measures of physical performance were similar between groups. DISCUSSION: The findings indicate that, despite maintaining independent living, community-dwelling, Irish cancer survivors face elevated risks of physical performance limitations including cumulative burden of limitations, compared to community-dwelling adults without a history of cancer. Functional impairments are reflected in bone density metrics, signalling a cohort at risk of falls, fracture and loss of independence.