Page 166 - Risk quantification and modification in older patients with colorectal cancer
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                                Chapter 8
Over the course of one year, functionally dependent patients persistently reported lower role functioning (b=-16.40; 95% CI -24.74 to -8.06), lower global health (b=- 7.0; 95% CI -13.6 to -0.3, p=0.04) and more fatigue (b=11.3; 95% CI 1.5 to 21.5), more pain (b=15.5; 95% CI 7.0 to 23.9), more gastrointestinal problems (b=7.0; 95% CI 1.8 to 12.2) and more weight loss (b=8.4; 95% CI 2.8 to 13.9) compared to functionally independent patients. This was also reflected in a lower summary score for functionally dependent patients (b=-8.0 95% CI -12.8 to -3.1).
Figures 2A and 2B illustrate that mean scores for role functioning, emotional functioning, fatigue, pain, global health, the HRQoL summary score, gastrointestinal problems and weight loss improved over time for functionally dependent patients and not for functionally independent patients. This was also reflected in the statistic interaction between time and dependency status (p<0.05), indicating that HRQoL significantly changes over time, but these changes differ between functionally dependent and independent patients.
After correction for confounders the improvement in functionally dependent patients was significant and clinically relevant at T3 compared to T0 for fatigue (b=-13.9; 95% CI -27.9 to 0.0) and for the HRQoL summary score (b=12.0; 95% CI 3.3 to 20.7). At T6 compared to T0 significant improvements (p<0.05) were observed in role functioning (b=17.1; 95% CI 1.4 to 32.7), fatigue (b=-18.6; 95% CI -31.0 to -6.2), gastrointestinal problems (-9.8; 95% CI -15.8 to -3.8), global health (b=13.7; 95% CI 3.0 to 24.3) and the HRQoL summary score (b=12.7, 95% CI 4.3 to 21.2). At T12 (versus T0) these improvements were only statistically significant and clinical relevant for weight loss (b=-18.8; 95% CI -34.9 to -2.7) and gastrointestinal problems (b=-10.4; 95% CI -20.0 to -0.7, p=0.04) and no longer for the other functioning and symptom scales.
In functionally independent patients, at T3 emotional functioning significantly improved (b=4.2 95% CI 0.6-7.8) although this difference was not clinically relevant. At T6 compared to T0 improvements were observed in emotional functioning (b=4.9 95% CI 1.3-8.6), pain (b=-7.1 95% CI -12.8 to -1.3), weight loss (b=-14.0 95% CI -20.4 to -7.5) and gastrointestinal problems (b=-4.2, 95% CI -7.2 to -1.3). At T12 (versus T0) the improvements in emotional functioning (b=4.7, 95% CI 0.9 to 8.5), weight loss (b=-12.5, 95% CI -18.9 to -6.1) and gastrointestinal problems (b=-3.3, 95% CI -6.4 to -0.2) remained significant but not for pain (p=0.08). The temporality improvement in the pain score and the improvement
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