학술논문
Instrumental activities of daily living in older patients with metastatic prostate cancer: results from the meet-URO network ADHERE prospective study.
Document Type
Article
Author
Fratino, Lucia; Polesel, Jerry; Giunta, Emilio Francesco; Maruzzo, Marco; Buti, Sebastiano; Hassan, Mona Ali; Basso, Umberto; Rebuzzi, Sara Elena; De Giorgi, Ugo; Cinausero, Marika; Lipari, Helga; Gamba, Teresa; Bimbatti, Davide; Dri, Arianna; Ermacora, Paola; Vignani, Francesca; Fornarini, Giuseppe; Rescigno, Pasquale; Banna, Giuseppe Luigi
Source
Subject
*ACTIVITIES of daily living
*OLDER patients
*PROSTATE cancer patients
*LUTEINIZING hormone releasing hormone
*ANDROGEN receptors
*WATCHFUL waiting
*PATIENT compliance
*EXECUTIVE function
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Language
ISSN
2045-2322
Abstract
Instrumental activities of daily living (IADL) are significant health indicators closely related to executive functions and able to detect mild cognitive impairment. A decline in IADL usually precedes ADL limitation, including taking medications, and may therefore predict a cognitive decline. We aimed to investigate the association of patients' IADL score with other clinical factors, with a particular focus on the presence of a caregiver, and the impact on adherence to androgen receptor pathway inhibitors (ARPIs) and survival outcomes within the Meet-URO 5—ADHERE study. It was a large prospective multicentre observational cohort study monitoring adherence to ARPIs in 234 metastatic castrate-resistant PC (mCRPC) patients aged ≥ 70. We observed an association between impaired IADL and lower geriatric G8 scores (p < 0.01), and lower adherence to ARPIs whether assessed by pill counting (p = 0.01) or self-reported by the patient himself (p = 0.03). The combination of an IADL < 6 and the absence of a caregiver resulted in a significantly high risk of non-adherence to the ARPIs at the multivariable analysis (HR 9.23, 95% confidence interval 2.28–37.43, p = 0.01). IADL alongside the geriatric G8 scales represent essential tools to identify frail and less auto-sufficient patients who are extremely vulnerable particularly if not supported by a caregiver and have the highest risk of nonadherence to ARPIs. [ABSTRACT FROM AUTHOR]