The Impact of Cancer on the Physical Function of the Elderly and Their Utilization of Health Care W e read with interest the article by Stafford and Cyr, who discuss the impact of solid tumors on the physical function of elderly patients, 1 and the accompanying editorial by Cohen, stressing the importance of applying the Comprehensive Geriatric Assessment (CGA) approach to assess the functional status of elderly cancer patients. 2 Since January 1995, a geriatrician has been added to the oncology team at the Department of Medical Oncology at the Centro di Riferimento Oncologico, Aviano, Italy (1 of the 7 Italian National Cancer Institutes), supporting the use of the CGA approach in elderly (i.e., age ี 65 years) cancer patients. Therefore, we believe it is appropriate to compare the preliminary results obtained among patients included in our CGA study with the findings reported by Stafford and Cyr. 1 Between January 1995 and October 1997, the functional status of 274 elderly patients (median age: 73 years; range, 65-93 years) diagnosed with solid tumors or hematologic malignancies who were admitted consecutively to the Department of Medical Oncology was evaluated prospectively (as well as performance status) using the CGA. A questionnaire, previously validated, 3 was administered by a geriatrician and a medical oncologist. Physical limitations were assessed using the activities of daily living (ADL) and the instrumental activities of daily living (IADL) scales. A patient was classified as having functional limitation if he/she was not able to perform independently the following activities: for ADL, bathing, dressing, using the toilet, eating, continence, and ability to get in/out of bed; for IADL, using the telephone, housekeeping, cooking meals, shopping, managing money, and taking prescribed medications. The prevalence of functional limitations is illustrated separately for patients with solid or hematologic malignancies in Table . The chi-square test was used to assess the statistical significance of the different proportions of functional limitations in these two groups of elderly patients. 4 In contrast to the findings reported by Stafford and Cyr, which showed that 48% of elderly cancer patients had at least 1 ADL limitation, in the current series only 15.7% of elderly cancer patients had ี 1 ADL limitations. The percentage of patients with ADL limitations ranged from 6.9% (for eating) to 12.8% (for dressing), with no significant differences observed between patients with solid tumors and those with hematologic malignancies (Table ).
At least 1 IADL limitation was found out to affect 44.5% of the 274 elderly cancer patients, a percentage very similar to that reported by Stafford and Cyr (49%). 1 Overall, the prevalence of IADL limitations varied between 7.0% (for using the telephone) and 23.8% (for shop-