Abstract
Purpose
To examine the prevalence and cancer-specific patterns of functional disabilities among US cancer survivors.
Methods
Data from 44,943 cancer survivors and 2,470,536 non-cancer adults aged 18 years and older from the 2017–2022 Behavioral Risk Factor Surveillance System were analyzed. Functional disabilities assessed included mobility disability (i.e. serious difficulty walking or climbing stairs) and self-care disability (i.e. self-reported difficulty dressing or bathing). Multivariable logistic regression models were used to assess the associations between functional disabilities and sociodemographic, lifestyle, and health-related factors.
Results
Cancer survivors tended to be older and non-Hispanic White than non-cancer adults. The prevalence of mobility disability (27.9% vs. 13.4%) and self-care disability (7.4% vs. 3.8%) were higher among cancer survivors compared to non-cancer adults. After multivariable adjustments, cancer survivors were more likely to report mobility (OR, 1.27 [95% CI: 1.21–1.33]) and self-care (OR, 1.24 [95% CI: 1.14–1.34]) disability than non-cancer adults. The prevalence of mobility (34.9% vs. 26.3%) and self-care disability (9.7% vs. 6.7%) was higher in cancer survivors who were receiving active cancer treatment than in those who had completed cancer treatment. Higher prevalence of mobility and self-care disabilities was observed in cancer survivors who were racial/ethnic minorities and with higher BMI, low physical activity, lower levels of education and/or income, comorbidities, and those experiencing cancer/treatment-related pain. Patterns of mobility and self-care disabilities varied across cancer types.
Conclusion
Over a quarter of US cancer survivors reported mobility disability, and nearly 10% reported self-care disability, with patterns varying across cancer types and treatment status. Racial/ethnic minorities, along with underserved groups and individuals with unhealthy lifestyles or comorbidities, were notably more impacted by functional disabilities, underscoring the need for targeted disability prevention efforts.
Introduction
With advances in early detection, diagnosis and treatment, cancer survival rates have improved substantially, with approximately 69% of survivors living 5 or more years post-diagnosis.1 It is estimated that 18.1 million Americans are living after a diagnosis of cancer, and this number is projected to rise to 26 million by 2040.2 Many cancer patients experience side effects from cancer and its treatment, which can lead to acute and long-term functional limitations and eventually disabilities.3 Cancer-related disabilities impair quality of life, limit patients’ ability to care for themselves, and induce substantial societal and economic burden. In 2019, an estimated 114,187 people living with and beyond cancer were unable to work and received Social Society Administration (SSA) disability benefits, with a resulting cost of $1.86 billion in SSA disability claims.4
The prevalence and correlates of physical disabilities among cancer survivors in the US have not been well studied.4 Preliminary evidence suggests that racial/ethnic minorities and underserved populations may be disproportionally affected by cancer-induced physical impairments and disabilities.5,6 Prior studies have also suggested that risk of disability following cancer diagnosis is related to cancer treatment, as patients tend to lose physical function as they proceed through chemotherapy and radiation.7–9 However, there are few data evaluating either the risk of disability based on other sociodemographic or cancer-related factors or strategies to prevent disability after cancer diagnosis.10.There is thus a pressing need to identify populations at high risk of functional loss after cancer diagnosis, in order to develop preventive and management strategies targeting cancer-related disabilities.
To address these knowledge gaps, this study aimed to examine the prevalence and cancer-specific patterns of physical disability by cancer diagnosis and sociodemographic and survivorship factors using data from the 2017–2022 Behavioral Risk Factor Surveillance System.
Methods
Study Population
This cross-sectional study used data from the Behavioral Risk Factor Surveillance System (BRFSS), a nationwide, telephone-based survey conducted by the US Centers for Disease Control and Prevention to collect information on health-related risk behaviors and chronic medical conditions among US adults aged 18 years or older.11 Participants who had information on cancer diagnosis and functional disability assessment from 2017–2022 BRFSS were included. This analysis was exempt from institutional review board review given that the BRFSS is a publicly available data set containing no personal identifying information.
Diagnosis of Cancer and Cancer-Related Factors
BRFSS participants were asked, “How many different types of cancer have you had?” Based on the National Cancer Institute’s definition that “an individual is considered a cancer survivor from the time of diagnosis through the balance of life”12, individuals who responded that they had one or more types of cancer were defined as cancer survivors, while others were defined as non-cancer adults. Cancer survivors were then asked about the most recent type of cancer with which they had been diagnosed, their age at the time of cancer diagnosis, and cancer treatment status (currently receiving, completed, refused, haven’t started, or not necessary). Years since cancer diagnosis were calculated by subtracting the participant’s age at the time of their first cancer diagnosis from age at BRFSS assessment. Cancer survivors who responded “yes” to the question “Do you currently have physical pain caused by your cancer or cancer treatment” were defined as having cancer/treatment-related pain.
Functional Disability Assessment
The BRFSS used a 6-question assessment of disability from the American Community Survey, which assesses the following disability types: hearing, vision, cognition or mental, independent living, mobility and self-care.5,13 The present analysis focused on mobility and self-care disabilities. Individuals who responded “yes” to the question “Do you have serious difficulty walking or climbing stairs?” were defined as having a mobility disability, and those responded “yes” to the question “Do you have difficulty dressing or bathing?” were defined as having a self-care disability.
Sociodemographic Characteristics, Lifestyle Factors and Health Conditions
Sociodemographic characteristics included age (years), sex (male, female), race/ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, non-Hispanic Native American, Hispanic, non-Hispanic other), education level (<high school, high school, >high school), family annual income (<$25,000, $25,000-$74,999, >$75,000), marital status (married, not married) and metropolitan status (metropolitan, nonmetropolitan). Smoking status was categorized as current, former, and never. Participants who reported any leisure-time physical activity or exercise (other than for employment) in the past 30 days were categorized as “physically active” and those who reported none as “physically inactive”.14 Self-reported health factors included body mass index (kg/m2; <18.5, 18.5-<25, 25-<30, ≥30), and chronic health conditions, including diabetes mellitus, heart disease, stroke, chronic obstructive pulmonary disease, arthritis and memory loss.
Statistical Analysis
All analyses were conducted following the BRFSS analytic guidelines and accounted for the complex sampling design to obtain population-representative estimates.15 Statistical tests were 2-sided and statistical significance was set at P < .05. Data analyses were performed using Stata, version 17.0 (StataCorp LLC).
Sample size (weighted %) and prevalence of mobility and self-care disability (95% confidence intervals [CIs]) were estimated by cancer diagnosis (cancer survivors vs. non-cancer adults) according to participants’ sociodemographic and lifestyle factors, health conditions, and cancer-related factors and type (cancer survivor only), respectively. Two-stage multivariable logistic regression models to evaluate correlates of mobility and self-care disability were adjusted for age (years), sex (male, female), race/ethnicity, educational level, family annual income, marital status, metropolitan status, body mass index, smoking status, leisure-time physical activity, and chronic health condition in the first stage, and course of cancer treatment, number of cancer types, age at cancer diagnosis, time since cancer diagnosis and cancer/treatment-related pain in the second stage. Stratified analysis was conducted by treatment status, age group, cancer/treatment-related pain and the number of cancer diagnosis. Forest plots were produced to illustrate multivariable-adjusted odds ratios and 95% CIs for functional disabilities comparing cancer survivors with non-cancer adults by cancer types.
Results
A total of 2,470,536 non-cancer adults (51.2% female) and 44,943 cancer survivors (56.9% female) were included in the current analysis (Table 1; Appendix Table A1–2). Cancer survivors tended to be older (median age [IQR]: 70 [61 to 77] vs. 57 [41 to 69] years), non-Hispanic White (79.4% vs. 60.5%), married (56.8% vs. 49.8%), physically inactive (31.4% vs. 25.7%) and were more likely to have a history of smoking (50.0% vs. 37.9%) and a diagnosis of diabetes (21.1% vs. 11.2%) and heart disease (15.8% vs. 6.4%), stroke (7.7% vs. 3.3%), chronic obstructive pulmonary disease (15.6% vs. 6.5%), and arthritis (43.4% vs. 21.0%) as compared with non-cancer adults (all P<0.05).
Table 1.
Sample Size and Prevalence of Functional Disabilities by Sociodemographic, Lifestyle and Health Conditions Among Non-Cancer Adults and Cancer Survivors Aged 18 Years and Older, BRFSS 2017–2022a
| Patient Characteristics | No. of Participants (Weighted %)b | Prevalence, % (95% CI) |
||||
|---|---|---|---|---|---|---|
| Mobility Disability | Self-Care Disability | |||||
|
|
|
|
||||
| Non-Cancer | Cancer | Non-Cancer | Cancer | Non-Cancer | Cancer | |
| All | 2432754 (100) | 47768 (100) | 13.4 (13.3 to 13.5) | 27.9 (27.1 to 28.7) | 3.8 (3.8 to 3.9) | 7.4 (6.9 to 7.9) |
| Age, y | ||||||
| Median [IQR] | 57 [41 to 69] | 70 [61 to 77] | ||||
| <65 | 1576215 (78.6) | 16011 (43.8) | 9.8 (9.7 to 9.9) | 23.7 (22.5 to 24.8) | 3.3 (3.2 to 3.3) | 8.4 (7.6 to 9.2) |
| ≥65 | 856539 (21.4) | 31757 (56.2) | 27.0 (26.7 to 27.2) | 31.2 (30.1 to 32.3) | 5.8 (5.7 to 5.9) | 6.6 (6.0 to 7.2) |
| Sex | ||||||
| Male | 1113388 (48.8) | 20067 (43.1) | 11.2 (11.1 to 11.3) | 24.6 (23.5 to 25.7) | 3.6 (3.5 to 3.7) | 7.0 (6.4 to 7.7) |
| Female | 1319366 (51.2) | 27701 (56.9) | 15.6 (15.4 to 15.7) | 30.4 (29.3 to 31.5) | 4.0 (3.9 to 4.1) | 7.7 (7.0 to 8.4) |
| Race/Ethnicity | ||||||
| Non-Hispanic White | 1802568 (60.5) | 39865 (79.4) | 13.5 (13.4 to 13.6) | 26.3 (25.5 to 27.2) | 3.4 (3.4 to 3.5) | 6.2 (5.7 to 6.7) |
| Non-Hispanic Black | 186815 (11.4) | 2189 (7.5) | 17.0 (16.7 to 17.3) | 35.1 (31.9 to 38.3) | 5.5 (5.3 to 5.7) | 11.3 (9.2 to 13.3) |
| Non-Hispanic Asian | 59135 (5.5) | 649 (1.5) | 5.3 (4.9 to 5.8) | 19.9 (13.0 to 26.8) | 1.5 (1.3 to 1.8) | 7.5 (2.2 to 12.7) |
| Non-Hispanic Native American | 52163 (1.2) | 909 (1.2) | 19.8 (19.0 to 20.6) | 40.6 (30.7 to 50.5) | 6.6 (6.2 to 7.1) | 20.6 (10.7 to 30.5) |
| Hispanic | 214591 (17.2) | 2048 (6.0) | 12.6 (12.3 to 12.9) | 36.1 (32.2 to 40.0) | 4.2 (4.1 to 4.4) | 12.1 (9.6 to 14.7) |
| Non-Hispanic Other | 117482 (4.2) | 2108 (4.2) | 15.7 (15.3 to 16.2) | 32.1 (28.1 to 36.1) | 5.2 (5.0 to 5.5) | 11.3 (8.4 to 14.3) |
| Educational level | ||||||
| <High school | 160774 (12.4) | 2551 (11.1) | 25.6 (25.2 to 26.0) | 49.1 (45.6 to 52.6) | 8.4 (8.2 to 8.7) | 15.6 (12.8 to 18.5) |
| High school/GED | 644337 (27.9) | 12219 (28.1) | 15.3 (15.1 to 15.4) | 33.0 (31.5 to 34.5) | 4.2 (4.1 to 4.3) | 8.3 (7.5 to 9.2) |
| >High school | 1627643 (59.7) | 32998 (60.8) | 10.1 (10.0 to 10.2) | 21.7 (20.9 to 22.5) | 2.7 (2.6 to 2.7) | 5.5 (5.0 to 5.9) |
| Family annual income | ||||||
| <$25,000 | 446488 (19.2) | 8609 (19.4) | 26.5 (26.2 to 26.8) | 51.2 (49.1 to 53.3) | 9.0 (8.8 to 9.2) | 16.9 (15.3 to 18.6) |
| $25,000 - $74,999 | 1249743 (49.7) | 26424 (53.6) | 13.7 (13.5 to 13.8) | 27.6 (26.6 to 28.6) | 3.5 (3.4 to 3.5) | 6.3 (5.8 to 6.9) |
| >$75,000 | 736523 (31.1) | 12735 (27) | 5.0 (4.9 to 5.1) | 11.7 (10.7 to 12.7) | 1.1 (1.1 to 1.2) | 2.6 (2.0 to 3.2) |
| Marital status | ||||||
| Not married | 1180389 (50.2) | 22189 (43.2) | 15.5 (15.3 to 15.6) | 36.5 (35.2 to 37.8) | 4.7 (4.7 to 4.8) | 10.5 (9.5 to 11.4) |
| Married | 1252365 (49.8) | 25579 (56.8) | 11.4 (11.3 to 11.5) | 21.4 (20.5 to 22.3) | 2.9 (2.8 to 2.9) | 5 (4.6 to 5.5) |
| Metropolitan status | ||||||
| Metropolitan counties | 1779527 (86.8) | 33582 (80.8) | 12.8 (12.7 to 12.9) | 27.0 (26.1 to 27.9) | 3.7 (3.6 to 3.7) | 7.1 (6.5 to 7.6) |
| Nonmetropolitan counties | 653227 (13.2) | 14186 (19.2) | 17.4 (17.2 to 17.6) | 31.6 (30.0 to 33.2) | 4.8 (4.7 to 4.9) | 8.8 (7.5 to 10.0) |
| Body mass index, kg/m2 | ||||||
| <18.5 | 37724 (1.8) | 836 (2.1) | 14.4 (13.7 to 15.1) | 40.1 (30.2 to 50.0) | 5.5 (5.0 to 6.0) | 15.2 (6.6 to 23.7) |
| 18.5 - <25 | 686422 (29.1) | 13057 (26) | 8.5 (8.4 to 8.7) | 22.0 (20.5 to 23.4) | 2.6 (2.5 to 2.7) | 6.6 (5.5 to 7.6) |
| 25 - <30 | 975489 (39.7) | 19099 (39.4) | 11.5 (11.4 to 11.7) | 22.8 (21.6 to 23.9) | 3.1 (3.0 to 3.2) | 5.3 (4.7 to 6.0) |
| ≥30 | 733119 (29.4) | 14776 (32.4) | 20.8 (20.6 to 21.0) | 38.1 (36.7 to 39.5) | 5.8 (5.7 to 5.9) | 10.0 (9.2 to 10.8) |
| Smoking status | ||||||
| Never smoker | 1440485 (62.1) | 24891 (50.0) | 9.9 (9.8 to 10.0) | 23.1 (22.1 to 24.2) | 2.6 (2.6 to 2.7) | 5.7 (5.0 to 6.4) |
| Former smoker | 662045 (23.5) | 17633 (36.1) | 18.3 (18.1 to 18.5) | 29.9 (28.6 to 31.1) | 5.0 (4.8 to 5.1) | 7.2 (6.5 to 7.8) |
| Current smoker | 330224 (14.4) | 5244 (13.9) | 20.5 (20.3 to 20.8) | 39.9 (37.4 to 42.4) | 7.0 (6.8 to 7.2) | 14.1 (12.1 to 16.0) |
| Leisure-time physical activity | ||||||
| Inactive | 634504 (25.7) | 14264 (31.4) | 27.3 (27.0 to 27.5) | 48.2 (46.7 to 49.8) | 8.7 (8.6 to 8.9) | 14.4 (13.2 to 15.6) |
| Active | 1798250 (74.3) | 33504 (68.6) | 8.6 (8.6 to 8.7) | 18.6 (17.8 to 19.4) | 2.1 (2.0 to 2.1) | 4.2 (3.7 to 4.6) |
| Diabetes | ||||||
| No | 2107186 (88.8) | 38013 (78.9) | 10.6 (10.5 to 10.7) | 23.8 (22.9 to 24.6) | 3.0 (2.9 to 3.0) | 6.3 (5.7 to 6.8) |
| Yes | 325568 (11.2) | 9755 (21.1) | 35.6 (35.2 to 36.0) | 43.4 (41.5 to 45.2) | 10.3 (10.0 to 10.5) | 11.5 (10.4 to 12.6) |
| Heart disease | ||||||
| No | 2223720 (93.6) | 40163 (84.2) | 11.6 (11.5 to 11.7) | 24.1 (23.3 to 24.9) | 3.2 (3.2 to 3.3) | 6.1 (5.6 to 6.6) |
| Yes | 209034 (6.4) | 7605 (15.8) | 40.8 (40.3 to 41.3) | 48.5 (46.2 to 50.7) | 12.2 (11.9 to 12.6) | 14.2 (12.7 to 15.8) |
| Stroke | ||||||
| No | 2332179 (96.7) | 44212 (92.3) | 12.3 (12.2 to 12.3) | 25.5 (24.8 to 26.3) | 3.3 (3.3 to 3.4) | 6.4 (5.9 to 6.9) |
| Yes | 100575 (3.3) | 3556 (7.7) | 48.2 (47.5 to 48.9) | 56.2 (52.8 to 59.5) | 17.5 (16.9 to 18.1) | 19.4 (16.6 to 22.3) |
| Chronic obstructive pulmonary disease | ||||||
| No | 2236509 (93.5) | 40920 (84.4) | 11.2 (11.1 to 11.3) | 22.9 (22.1 to 23.7) | 3.0 (3.0 to 3.1) | 5.5 (5.1 to 6.0) |
| Yes | 196245 (6.5) | 6848 (15.6) | 45.9 (45.4 to 46.4) | 54.9 (52.7 to 57.1) | 15.0 (14.7 to 15.3) | 17.5 (15.6 to 19.4) |
| Arthritis | ||||||
| No | 1767874 (79.0) | 26744 (56.6) | 7.6 (7.5 to 7.7) | 17.5 (16.7 to 18.3) | 2.2 (2.1 to 2.2) | 4.6 (4.1 to 5.1) |
| Yes | 664880 (21.0) | 21024 (43.4) | 35.3 (35.1 to 35.6) | 41.5 (40.1 to 42.8) | 10.0 (9.8 to 10.1) | 11.0 (10.1 to 11.9) |
| Memory loss | ||||||
| No | 2402585 (99.0) | 46345 (97.0) | 13.0 (13.0 to 13.1) | 27.1 (26.3 to 27.9) | 3.6 (3.6 to 3.7) | 7.1 (6.6 to 7.6) |
| Yes | 30169 (1.0) | 1423 (3.0) | 51.4 (50.2 to 52.6) | 53.5 (47.6 to 59.3) | 20.3 (19.4 to 21.2) | 16.7 (12.8 to 20.7) |
| Course of cancer treatment | ||||||
| Current | 5690 (10.8) | 34.9 (32.5 to 37.3) | 9.8 (8.2 to 11.4) | |||
| Completed | 24422 (46.9) | 26.3 (25.1 to 27.5) | 6.7 (6.0 to 7.5) | |||
| Refused | 378 (0.9) | 53.7 (43.5 to 63.8) | 21.5 (12.4 to 30.6) | |||
| Not started | 1355 (2.8) | 33.4 (28.8 to 38.1) | 12.3 (8.6 to 15.9) | |||
| Not needed | 6918 (13.2) | 27.1 (25.2 to 29.0) | 6.4 (5.4 to 7.4) | |||
| Number of cancer types | ||||||
| 1 | 37103 (78.9) | 26.3 (25.5 to 27.2) | 6.8 (6.2 to 7.3) | |||
| 2 | 8644 (17.0) | 31.7 (29.7 to 33.6) | 8.5 (7.5 to 9.6) | |||
| ≥3 | 2021 (4.1) | 43.1 (38.0 to 48.2) | 14.6 (10.6 to 18.7) | |||
| Age at cancer diagnosis, y | ||||||
| ≥65 | 16330 (29.2) | 33.7 (32.3 to 35.1) | 7.6 (6.6 to 8.6) | |||
| 51–64 | 15255 (31.3) | 25.9 (24.6 to 27.2) | 5.9 (5.2 to 6.5) | |||
| 40–50 | 8669 (19.5) | 25.1 (22.9 to 27.2) | 7.5 (6.1 to 8.9) | |||
| <40 | 7514 (20) | 25.4 (23.8 to 27.0) | 9.3 (8.3 to 10.4) | |||
| Time since cancer diagnosis, y | ||||||
| 0–1 | 5614 (12.1) | 27.3 (25.1 to 29.6) | 7.6 (6.1 to 9.1) | |||
| 2–5 | 10483 (22.7) | 25.0 (23.5 to 26.5) | 6.3 (5.5 to 7.1) | |||
| ≥6 | 31671 (65.2) | 29.0 (28.0 to 30.0) | 7.7 (7.1 to 8.4) | |||
| Cancer/treatment-related pain | ||||||
| No | 43403 (90.0) | 26.2 (25.4 to 27.0) | 6.5 (6.0 to 7.0) | |||
| Yes | 4365 (10.0) | 43.2 (40.6 to 45.8) | 15.7 (13.8 to 17.6) | |||
All estimates were weighted.
Weighted percentage may not sum to 100% due to missing data
Prevalence of Mobility Disability in Cancer Survivors and Non-Cancer Adults
The prevalence of mobility disability (i.e., having serious difficulty walking or climbing stairs) was higher in cancer survivors (27.9% [95% CI: 27.1 to 28.7]) than in non-cancer adults (13.4% [95% CI, 13.3 to 13.5]) (Table 1). After adjusting for age, race/ethnicity, other sociodemographic factors, lifestyle behaviors, and chronic conditions, cancer survivors were more likely to report mobility disability than non-cancer adults (OR, 1.21 [95% CI: 1.16 to 1.26]; Figure 1).
Figure 1. Cancer-Specific Odds Ratio and 95% CI for Functional Disabilities Comparing Cancer Survivor With Non-Cancer Adults, BRFSS 2016–2021a.
a Adjusted for age (years), sex (male, female), race/ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, non-Hispanic Native American, Hispanic, non-Hispanic other), educational level (<high school, high school,>high school), family annual income (<$25,000, $25,000 - $74,999, >$75,000), marital status(married, not married) and metropolitan status (metropolitan, nonmetropolitan), body mass index (<18.5, 18.5 - <25, 25 - <30, ≥30), smoking status (current, former, never), leisure-time physical activity (inactive, active), and chronic conditions (no, any).
Mobility Disability and Sociodemographic, Lifestyle and Health Factors in Cancer Survivors
The prevalence of mobility disability was higher in cancer survivors ≥65 years old (31.2% [95% CI: 30.1 to 32.3]) than in those <65 years old (23.7% [95% CI: 22.5 to 24.8]; OR, 1.24 [95% CI: 1.11 to 1.38]) (Table 1–2; Appendix Table A3–4). Female cancer survivors reported significantly higher prevalence of mobility disability than males (OR, 1.25 [95% CI, 1.14 to 1.37]). The prevalence of mobility disability was higher in non-Hispanic Blacks (35.1% [95% CI: 31.9 to 38.3]) and non-Hispanic Native Americans (40.6% [95% CI: 30.7 to 50.5]), and Hispanics (36.1% [32.2 to 40.0]) than in non-Hispanic Whites (26.3% [95% CI: 25.5 to 27.2]). In multivariable analyses, mobility disability was more common in Hispanic survivors (OR, 1.29 [95% CI, 1.06 to 1.56]), but not other race/ethnic minority groups as compared to non-Hispanic White cancer survivors.
Table 2.
Logistic Regression Models for Functional Disabilities, Adjusted for Sociodemographic and Lifestyle Factors, Health Conditions and Cancer-Related Factors Among US Adults Aged 20 Years and Older, BRFSS 2017–2022a
| Patient Characteristics | Odds Ratio (95% CI) |
|||
|---|---|---|---|---|
| Mobility Disability | Self-Care Disability | |||
|
|
|
|||
| MV model 1 | MV model 2 | MV model 1 | MV model 2 | |
| Age, y | ||||
| <65 | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| ≥65 | 1.31 (1.19 to 1.44) | 1.20 (1.07 to 1.34) | 0.67 (0.57 to 0.78) | 0.68 (0.56 to 0.83) |
| Sex | ||||
| Male | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Female | 1.26 (1.15 to 1.37) | 1.25 (1.14 to 1.37) | 0.87 (0.75 to 1.01) | 0.84 (0.72 to 0.97) |
| Race/Ethnicity | ||||
| Non-Hispanic White | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Non-Hispanic Black | 1.15 (0.96 to 1.37) | 1.14 (0.95 to 1.36) | 1.42 (1.11 to 1.80) | 1.45 (1.13 to 1.86) |
| Non-Hispanic Asian | 1.19 (0.83 to 1.70) | 1.26 (0.88 to 1.80) | 1.80 (0.94 to 3.46) | 2.00 (1.00 to 4.00) |
| Non-Hispanic Native American | 1.42 (0.82 to 2.45) | 1.38 (0.82 to 2.33) | 2.65 (1.20 to 5.84) | 2.53 (1.14 to 5.60) |
| Hispanic | 1.30 (1.07 to 1.59) | 1.29 (1.06 to 1.56) | 1.60 (1.21 to 2.13) | 1.57 (1.18 to 2.08) |
| Non-Hispanic Other | 1.26 (1.02 to 1.55) | 1.21 (0.98 to 1.50) | 1.72 (1.27 to 2.33) | 1.60 (1.18 to 2.15) |
| Educational level | ||||
| <High school | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| High school/GED | 1.47 (1.24 to 1.74) | 1.42 (1.19 to 1.68) | 1.27 (0.99 to 1.63) | 1.23 (0.96 to 1.58) |
| >High school | 1.14 (1.04 to 1.26) | 1.14 (1.04 to 1.26) | 1.01 (0.87 to 1.17) | 1.02 (0.87 to 1.19) |
| Annual income | ||||
| <$25,000 | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| $25,000 - $74,999 | 3.36 (2.88 to 3.92) | 3.27 (2.81 to 3.80) | 3.17 (2.28 to 4.40) | 3.02 (2.21 to 4.13) |
| >$75,000 | 1.79 (1.59 to 2.02) | 1.77 (1.57 to 2.00) | 1.74 (1.30 to 2.32) | 1.71 (1.30 to 2.26) |
| Marital status | ||||
| Not married | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Married | 1.31 (1.19 to 1.44) | 1.30 (1.18 to 1.43) | 1.32 (1.11 to 1.56) | 1.30 (1.10 to 1.53) |
| Metropolitan status | ||||
| Metropolitan counties | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Nonmetropolitan counties | 1.03 (0.94 to 1.13) | 1.02 (0.93 to 1.12) | 1.07 (0.91 to 1.26) | 1.07 (0.91 to 1.26) |
| Body mass index, kg/m2 | ||||
| <18.5 | 1.33 (0.97 to 1.81) | 1.30 (0.95 to 1.79) | 1.27 (0.67 to 2.41) | 1.23 (0.63 to 2.40) |
| 18.5 - <25 | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| 25 - <30 | 1.07 (0.95 to 1.20) | 1.09 (0.97 to 1.22) | 0.79 (0.64 to 0.99) | 0.81 (0.65 to 1.00) |
| ≥30 | 1.87 (1.67 to 2.10) | 1.97 (1.76 to 2.21) | 1.17 (0.96 to 1.43) | 1.22 (0.99 to 1.49) |
| Smoking status | ||||
| Never smoker | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Former smoker | 1.15 (1.05 to 1.27) | 1.15 (1.05 to 1.26) | 1.04 (0.88 to 1.23) | 1.04 (0.88 to 1.23) |
| Current smoker | 1.37 (1.20 to 1.57) | 1.38 (1.20 to 1.58) | 1.36 (1.11 to 1.67) | 1.30 (1.06 to 1.60) |
| Physical Activity | ||||
| Active | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Inactive | 2.83 (2.59 to 3.09) | 2.79 (2.55 to 3.04) | 2.62 (2.25 to 3.04) | 2.59 (2.23 to 3.01) |
| Chronic conditionsb | ||||
| No | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Any | 4.00 (3.59 to 4.44) | 3.89 (3.50 to 4.33) | 3.87 (3.17 to 4.72) | 3.79 (3.10 to 4.63) |
| Course of cancer treatment | ||||
| Current | 1.32 (1.14 to 1.52) | 1.22 (0.97 to 1.53) | ||
| Completed | 1 [Reference] | 1 [Reference] | ||
| Refused | 1.96 (1.32 to 2.92) | 1.70 (1.01 to 2.87) | ||
| Not started | 1.25 (0.98 to 1.59) | 1.51 (1.02 to 2.22) | ||
| Not needed | 0.98 (0.86 to 1.12) | 0.95 (0.77 to 1.18) | ||
| Number of cancer types | ||||
| 1 | 1 [Reference] | 1 [Reference] | ||
| 2 | 1.12 (1.00 to 1.26) | 1.13 (0.94 to 1.36) | ||
| ≥3 | 1.61 (1.28 to 2.02) | 1.63 (1.12 to 2.35) | ||
| P for trend | <.001 | <.001 | ||
| Age at cancer diagnosis, y | ||||
| ≥65 | 1 [Reference] | 1 [Reference] | ||
| 51–64 | 0.77 (0.68 to 0.86) | 0.70 (0.57 to 0.86) | ||
| 40–50 | 0.79 (0.68 to 0.92) | 0.91 (0.67 to 1.22) | ||
| <40 | 0.70 (0.60 to 0.82) | 0.94 (0.73 to 1.23) | ||
| Time since cancer diagnosis, y | ||||
| 0–1 | 1 [Reference] | 1 [Reference] | ||
| 2–5 | 0.90 (0.77 to 1.05) | 0.86 (0.66 to 1.13) | ||
| ≥6 | 1.16 (1.00 to 1.35) | 1.06 (0.82 to 1.39) | ||
| Cancer/treatment-related pain | ||||
| No | 1 [Reference] | 1 [Reference] | ||
| Yes | 1.97 (1.71 to 2.28) | 1.95 (1.61 to 2.36) | ||
All estimates were weighted.
Chronic conditions included diabetes, heart diseases, stroke, chronic obstructive pulmonary disease, arthritis and memory loss.
Low educational attainment, low family annual income, being unmarried, having obesity, current smoking, being physically inactive, and having a chronic condition, were also associated with a higher prevalence of mobility disability in cancer survivors. Notably, the relationship between mobility disability and these socioeconomic, lifestyle behaviors and health conditions remained significant in multivariable models (Table 2).
Mobility Disability and Cancer-Related Factors in Cancer Survivors
Cancer survivors who were receiving active treatment were more likely to experience cancer/treatment-related pain (20.2% vs. 9.9%) compared to those who had completed treatment. The prevalence of mobility disability was higher in cancer survivors who were receiving active cancer treatment (34.9%, 95% CI: 32.5 to 37.3) than in those who had completed cancer treatment (26.3%, 95% CI: 25.1 to 27.5) in the cohort overall (OR, 1.32 [95% CI, 1.14 to 1.52) and in subgroups defined by patient characteristics (Table 3).
Table 3.
Sample Size and Prevalence of Functional Disabilities by Sociodemographic, Lifestyle and Health Conditions Among Cancer Survivors Aged 18 Years According to Course of Cancer Treatment, BRFSS 2017–2022a
| Patient Characteristics | No. of Participants (Weighted %)b | Prevalence, % (95% CI) |
||||
|---|---|---|---|---|---|---|
| Mobility Disability | Self-Care Disability | |||||
|
|
|
|
||||
| Current Receiving | Completed | Current Receiving | Completed | Current Receiving | Completed | |
| All | 5690 (100) | 24422 (100) | 34.9 (32.5 to 37.3) | 26.3 (25.1 to 27.5) | 9.8 (8.2 to 11.4) | 6.7 (6.0 to 7.5) |
| Age, y | ||||||
| Median [IQR] | 70 [61 to 77] | 64 [61 to 77] | ||||
| <65 | 1894 (44.0) | 8400 (44.8) | 32.7 (29.1 to 36.4) | 21.1 (19.5 to 22.7) | 10.9 (8.5 to 13.3) | 7.5 (6.3 to 8.7) |
| ≥65 | 3796 (56.0) | 16022 (55.2) | 36.6 (33.5 to 39.7) | 30.6 (28.9 to 32.2) | 9.0 (6.8 to 11.2) | 6.1 (5.2 to 7.1) |
| Sex | ||||||
| Male | 2567 (44.3) | 10007 (42.9) | 33.7 (30.2 to 37.2) | 22.3 (20.8 to 23.8) | 10.3 (7.9 to 12.6) | 5.5 (4.6 to 6.3) |
| Female | 3123 (55.7) | 14415 (57.1) | 35.9 (32.7 to 39.1) | 29.3 (27.6 to 31.1) | 9.5 (7.2 to 11.7) | 7.7 (6.6 to 8.8) |
| Race/Ethnicity | ||||||
| Non-Hispanic White | 4509 (72.8) | 20577 (80.0) | 32.0 (29.4 to 34.6) | 24.7 (23.4 to 25.9) | 7.6 (6.2 to 9.1) | 5.8 (4.9 to 6.6) |
| Non-Hispanic Black | 348 (11.1) | 1076 (7.5) | 40.9 (32.5 to 49.4) | 33.1 (28.6 to 37.7) | 13.4 (7.7 to 19.2) | 10.5 (7.6 to 13.5) |
| Non-Hispanic Asian | 106 (1.8) | 283 (1.5) | 42.0 (21.9 to 62.1) | 18.7 (8.0 to 29.4) | 10.8 (0 to 22.2) | 8.4 (0 to 18.3) |
| Non-Hispanic Native American | 133 (1.3) | 491 (1.0) | 56.2 (37.2 to 75.3) | 43.1 (32.0 to 54.2) | 20.9 (5.8 to 36.1) | 23 (12.1 to 33.9) |
| Hispanic | 348 (9.6) | 1003 (6.1) | 46.0 (36.7 to 55.4) | 36.4 (30.2 to 42.6) | 19.5 (10 to 29.1) | 9.5 (6.7 to 12.3) |
| Non-Hispanic Other | 246 (3.4) | 992 (3.9) | 34.1 (24.9 to 43.3) | 30.5 (25.3 to 35.7) | 13.2 (6.4 to 20.1) | 10.3 (6.5 to 14.1) |
| Educational level | ||||||
| <High school | 378 (14.5) | 1212 (10.6) | 50.6 (42.6 to 58.7) | 50.6 (44.8 to 56.4) | 22.2 (14.1 to 30.3) | 14.6 (9.9 to 19.4) |
| High school/GED | 1440 (29.2) | 6120 (27.9) | 39.7 (35.0 to 44.3) | 31.8 (29.5 to 34.0) | 8.8 (6.4 to 11.2) | 8.6 (7.2 to 10.0) |
| >High school | 3872 (56.3) | 17090 (61.5) | 28.3 (25.8 to 30.9) | 19.7 (18.7 to 20.7) | 7.2 (5.9 to 8.4) | 4.5 (3.9 to 5.1) |
| Family annual income | ||||||
| <$25,000 | 1138 (24.2) | 4246 (18.8) | 52.9 (47.7 to 58.2) | 51.4 (48.0 to 54.7) | 18.7 (13.8 to 23.6) | 16.7 (14.0 to 19.5) |
| $25,000 - $74,999 | 3119 (51.6) | 13308 (51.7) | 33.1 (29.9 to 36.3) | 26.5 (25.1 to 27.9) | 8.0 (6.2 to 9.7) | 5.9 (4.9 to 6.8) |
| >$75,000 | 1433 (24.2) | 6868 (29.5) | 20.7 (16.8 to 24.7) | 10.1 (8.8 to 11.4) | 4.9 (2.9 to 6.9) | 1.9 (1.4 to 2.4) |
| Marital status | ||||||
| Not married | 2609 (43.5) | 11046 (41.9) | 40.8 (37.1 to 44.5) | 35.7 (33.6 to 37.8) | 12.1 (9.3 to 15) | 10.5 (8.9 to 12.0) |
| Married | 3081 (56.5) | 13376 (58.1) | 30.3 (27.3 to 33.4) | 19.6 (18.3 to 20.8) | 8.0 (6.2 to 9.9) | 4.0 (3.5 to 4.6) |
| Metropolitan status | ||||||
| Metropolitan counties | 3932 (81.1) | 16834 (81.0) | 34.7 (32.0 to 37.4) | 25.3 (23.9 to 26.6) | 9.6 (7.7 to 11.5) | 6.3 (5.5 to 7.0) |
| Nonmetropolitan counties | 1758 (18.9) | 7588 (19.0) | 35.8 (30.9 to 40.6) | 30.8 (28.4 to 33.2) | 10.7 (8 to 13.4) | 8.6 (6.4 to 10.8) |
| Body mass index, kg/m2 | ||||||
| <18.5 | 106 (1.8) | 408 (2.3) | 50.4 (32.3 to 68.4) | 42.8 (26.1 to 59.4) | 19 (6.2 to 31.8) | 14.9 (0 to 30.0) |
| 18.5 - <25 | 1611 (27.9) | 6542 (25.3) | 31.0 (26.2 to 35.8) | 19.3 (17.5 to 21.2) | 10.9 (7 to 14.9) | 5.7 (4.4 to 7.0) |
| 25 - <30 | 2219 (39.0) | 9894 (40.8) | 28.2 (24.7 to 31.8) | 21.6 (19.9 to 23.3) | 8.1 (5.8 to 10.4) | 4.6 (3.7 to 5.6) |
| ≥30 | 1754 (31.3) | 7578 (31.6) | 45.8 (41.7 to 49.9) | 36.9 (34.8 to 39.0) | 10.5 (8.1 to 12.9) | 9.7 (8.5 to 10.9) |
| Smoking status | ||||||
| Never smoker | 2910 (48.7) | 12858 (50.6) | 31.1 (27.7 to 34.6) | 22.1 (20.6 to 23.6) | 9.0 (6.6 to 11.5) | 5.2 (4.2 to 6.1) |
| Former smoker | 2196 (37.7) | 8956 (36.2) | 35.9 (32.2 to 39.5) | 28.2 (26.3 to 30.1) | 8.8 (6.7 to 11) | 6.7 (5.8 to 7.7) |
| Current smoker | 584 (13.6) | 2608 (13.2) | 45.6 (38.5 to 52.7) | 37.6 (33.5 to 41.8) | 15.3 (9.8 to 20.9) | 12.8 (9.6 to 16) |
| Leisure-time physical activity | ||||||
| Inactive | 1997 (35.6) | 6868 (30.1) | 51.9 (48.2 to 55.6) | 47.3 (44.8 to 49.8) | 15 (12.3 to 17.7) | 14.2 (12.1 to 16.2) |
| Active | 3693 (64.4) | 17554 (69.9) | 25.5 (22.5 to 28.5) | 17.3 (16.1 to 18.5) | 7.0 (4.9 to 9.0) | 3.5 (3.0 to 4.1) |
| Diabetes | ||||||
| No | 4437 (75.5) | 19555 (79.6) | 30.3 (27.7 to 32.9) | 22.4 (21.1 to 23.7) | 8.8 (7 to 10.7) | 5.7 (4.9 to 6.6) |
| Yes | 1253 (24.5) | 4867 (20.4) | 49.1 (44.1 to 54.1) | 41.7 (38.9 to 44.4) | 12.9 (9.4 to 16.3) | 10.7 (9.1 to 12.3) |
| Heart disease | ||||||
| No | 4710 (81.7) | 20716 (85.2) | 30.7 (28.2 to 33.1) | 22.9 (21.6 to 24.1) | 8.2 (6.6 to 9.9) | 5.8 (5.0 to 6.7) |
| Yes | 980 (18.3) | 3706 (14.8) | 53.9 (48.0 to 59.7) | 46.4 (42.9 to 49.8) | 16.9 (12.2 to 21.7) | 11.8 (9.9 to 13.8) |
| Stroke | ||||||
| No | 5257 (92.2) | 22709 (92.5) | 33 (30.5 to 35.4) | 23.9 (22.8 to 25.1) | 8.7 (7.1 to 10.3) | 6.1 (5.3 to 6.8) |
| Yes | 433 (7.8) | 1713 (7.5) | 57.8 (49.2 to 66.4) | 56.1 (50.4 to 61.8) | 23.1 (14.6 to 31.7) | 15 (11.7 to 18.3) |
| Chronic obstructive pulmonary disease | ||||||
| No | 4850 (83.6) | 21082 (85.6) | 29.9 (27.5 to 32.3) | 22.0 (20.9 to 23.2) | 7.9 (6.3 to 9.5) | 5.1 (4.5 to 5.8) |
| Yes | 840 (16.4) | 3340 (14.4) | 60.5 (54.5 to 66.5) | 52.0 (48.5 to 55.4) | 19.7 (14.3 to 25) | 16.2 (13.2 to 19.3) |
| Arthritis | ||||||
| No | 3267 (56.3) | 13588 (56.8) | 24.1 (21.4 to 26.8) | 15.7 (14.5 to 16.9) | 6.2 (4.9 to 7.6) | 3.8 (3.1 to 4.5) |
| Yes | 2423 (43.7) | 10834 (43.2) | 48.7 (45.0 to 52.5) | 40.3 (38.3 to 42.3) | 14.4 (11.3 to 17.6) | 10.6 (9.2 to 12.1) |
| Memory loss | ||||||
| No | 5515 (97.2) | 23801 (96.9) | 34.3 (31.9 to 36.7) | 25.5 (24.4 to 26.7) | 9.5 (7.9 to 11.2) | 6.4 (5.7 to 7.2) |
| Yes | 175 (2.8) | 621 (3.1) | 55.3 (42.8 to 67.9) | 52.3 (41.7 to 62.9) | 20.1 (8.9 to 31.3) | 16.4 (9.6 to 23.3) |
| Number of cancer types | ||||||
| 1 | 3969 (72.5) | 19350 (80.4) | 33.3 (30.4 to 36.1) | 24.9 (23.6 to 26.1) | 9.2 (7.2 to 11.2) | 6.6 (5.7 to 7.5) |
| 2 | 1312 (21.5) | 4259 (16.4) | 38.1 (33.4 to 42.9) | 30.7 (27.4 to 33.9) | 11.2 (8.2 to 14.2) | 6.8 (5.4 to 8.1) |
| ≥3 | 409 (6.0) | 813 (3.2) | 43.0 (35.0 to 51.0) | 41.7 (31.7 to 51.6) | 12.3 (6.8 to 17.8) | 10.5 (6.1 to 14.8) |
| Age at cancer diagnosis, y | ||||||
| ≥65 | 2383 (35.4) | 7670 (26.9) | 39.2 (35.1 to 43.3) | 33.4 (31.2 to 35.6) | 10.0 (6.6 to 13.4) | 7.5 (5.9 to 9.1) |
| 51–64 | 1952 (36.8) | 7899 (30.4) | 31.9 (28.2 to 35.6) | 24.2 (22.4 to 26.1) | 8.4 (6.4 to 10.4) | 5.0 (4.0 to 6.0) |
| 40–50 | 844 (15.5) | 4733 (21.5) | 31.7 (26.1 to 37.2) | 23.2 (19.6 to 26.7) | 12 (7.8 to 16.2) | 6.4 (4.4 to 8.3) |
| <40 | 511 (12.3) | 4120 (21.2) | 35.5 (28.3 to 42.6) | 23.6 (21.6 to 25.7) | 10.9 (7.1 to 14.7) | 8.6 (7.2 to 10) |
| Time since cancer diagnosis, y | ||||||
| 0–1 | 1361 (25.6) | 2083 (8.4) | 31.3 (26.2 to 36.4) | 24.3 (20.8 to 27.8) | 9.6 (5.5 to 13.8) | 5.9 (3.5 to 8.3) |
| 2–5 | 1611 (28.7) | 5085 (21.2) | 33.9 (29.6 to 38.2) | 22.5 (20.4 to 24.5) | 8.4 (6.0 to 10.7) | 5.7 (4.5 to 7.0) |
| ≥6 | 2718 (45.7) | 17254 (70.5) | 37.5 (34.1 to 40.9) | 27.7 (26.2 to 29.2) | 10.9 (8.6 to 13.1) | 7.1 (6.2 to 8.1) |
| Cancer/treatment-related pain | ||||||
| No | 4655 (79.8) | 22207 (90.1) | 30.8 (28.2 to 33.4) | 25.1 (23.8 to 26.3) | 7.3 (5.7 to 8.9) | 6.2 (5.4 to 7.0) |
| Yes | 1035 (20.2) | 2215 (9.9) | 51.1 (45.9 to 56.3) | 37.8 (33.8 to 41.8) | 19.9 (15 to 24.7) | 11.8 (9.6 to 14.0) |
All estimates were weighted.
Weighted percentage may not sum to 100% due to missing data
The prevalence of mobility disability was also higher in individuals diagnosed with two or more cancers (vs. one cancer: 33.9% [95% CI, 32.0 to 35.8 vs. 26.3% [95% CI, 25.5 to 27.2]; P for trend<0.001; Appendix Table A5). and those with cancer/treatment-related pain (vs. without cancer/treatment-related pain: 43.2% [95% CI, 40.6 to 45.8] vs. 26.2% [95% CI, 25.4 to 27.0]; OR, 1.97 [95% CI, 1.71 to 2.28]; Appendix Table A6).
Cancer-Specific Patterns of Mobility Disability
Among individuals diagnosed with common cancers, the prevalence of mobility disability was 28.0% (95% CI: 26.0 to 30.1) for breast, 22.9% (95% CI: 20.7 to 25.0) for prostate, 42.0% (95% CI: 37.3 to 46.8) for larynx/trachea and lung and 28.8% (95% CI: 25.7 to 31.9) for colorectal cancers (Table 4). The prevalence of mobility disability was highest in survivors with cancers of the bone (46.4%, 95% CI: 37.3 to 55.4), liver (42.6%, 95% CI: 31.5 to 53.8), and larynx/trachea and lung.
Table 4.
Prevalence of Mobility Disability by Cancer Type and Course of Cancer Treatment Among US Cancer Survivors Aged 18 Years and Older, BRFSS 2017–2022a
| Cancer Type | Course of Cancer Treatment |
|||||
|---|---|---|---|---|---|---|
| Overall | Current | Complete | ||||
|
|
|
|
||||
| No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | |
| All | 47768 | 27.9 (27.1 to 28.7) | 5690 | 34.9 (32.5 to 37.3) | 24422 | 26.3 (25.1 to 27.5) |
| Oral Cavity & Pharynx | 442 | 32.8 (24.5 to 41.1) | 41 | 45.0 (8.0 to 82.0) | 271 | 28.2 (18.7 to 37.6) |
| Head and Neck | 147 | 28.8 (18.9 to 38.8) | 15 | 37.0 (0 to 77.8) | 85 | 23.1 (11.2 to 35.0) |
| Digestive System | ||||||
| Esophagus & Stomach | 395 | 34.3 (27.0 to 41.7) | 66 | 48.5 (27.5 to 69.4) | 175 | 25.6 (15.7 to 35.4) |
| Colon & Rectum | 2559 | 28.8 (25.7 to 31.9) | 231 | 25.4 (17.1 to 33.7) | 1359 | 27.3 (23.1 to 31.5) |
| Liver | 255 | 42.6 (31.5 to 53.8) | 86 | 48.7 (28.6 to 68.7) | 84 | 31.5 (16.4 to 46.6) |
| Pancreas | 205 | 34.9 (23.8 to 46.1) | 58 | 38.3 (16.7 to 59.9) | 62 | 15.4 (4.4 to 26.3) |
| Respiratory System | ||||||
| Larynx/Trachea & Lung | 1426 | 42.0 (37.3 to 46.8) | 289 | 44.7 (33.4 to 56.0) | 631 | 44.2 (37.4 to 51.0) |
| Musculoskeletal System | ||||||
| Bone | 264 | 46.4 (37.3 to 55.4) | 98 | 57.5 (42.2 to 72.8) | 79 | 48.2 (32.3 to 64.0) |
| Skin | ||||||
| Melanoma | 9281 | 23.6 (21.8 to 25.3) | 577 | 34.9 (27.2 to 42.7) | 4531 | 22.7 (20.0 to 25.4) |
| Breast | 9467 | 28.0 (26.0 to 30.1) | 1536 | 30.3 (26.1 to 34.5) | 5432 | 27.5 (24.4 to 30.5) |
| Reproductive System | ||||||
| Cervix | 2011 | 34.8 (30.2 to 39.3) | 57 | 35.3 (16.8 to 53.8) | 1174 | 36.7 (29.6 to 43.8) |
| Uterus | 1341 | 36.5 (32.4 to 40.6) | 63 | 38.9 (19.6 to 58.3) | 737 | 32.8 (27.4 to 38.2) |
| Ovary | 833 | 30.8 (24.3 to 37.4) | 99 | 43.3 (23.8 to 62.8) | 440 | 21.9 (15.8 to 28.0) |
| Prostate | 5909 | 22.9 (20.7 to 25.0) | 840 | 33.6 (27.3 to 39.9) | 3171 | 22.4 (19.3 to 25.6) |
| Testis | 306 | 15.2 (9.0 to 21.3) | NA | NA | 208 | 13.0 (6.0 to 20.0) |
| Urinary System | ||||||
| Bladder | 1316 | 28.0 (23.7 to 32.3) | 201 | 26.9 (17.6 to 36.3) | 673 | 26.7 (20.5 to 32.8) |
| Kidney | 894 | 33.5 (28.5 to 38.4) | 94 | 50.8 (35.4 to 66.1) | 403 | 32.1 (24.4 to 39.9) |
| Brain | 197 | 36.9 (25.9 to 48.0) | 37 | 24.1 (5.6 to 42.5) | 95 | 34.8 (20.0 to 49.6) |
| Endocrine System | ||||||
| Thyroid | 1398 | 22.8 (19.0 to 26.7) | 104 | 43.4 (22.7 to 64.2) | 804 | 19.3 (15.1 to 23.4) |
| Lymphoma | 1368 | 22.8 (19.3 to 26.3) | 177 | 26.2 (16.4 to 36.1) | 817 | 22.1 (17.6 to 26.7) |
| Blood | ||||||
| Leukemia | 945 | 29.9 (24.5 to 35.3) | 290 | 35.8 (26.6 to 45.1) | 262 | 20.3 (9.8 to 30.8) |
| Otherb | 6761 | 28.7 (26.8 to 30.6) | 717 | 36.0 (28.6 to 43.4) | 2902 | 27.3 (24.4 to 30.3) |
All estimates were weighted.
Other cancer types include those not listed above.
The prevalence of mobility disability across individual malignancies was higher in survivors who were receiving active cancer treatment (vs. completed cancer treatment, Table 4), were older than 65 years (vs. younger than 65 years, Appendix Table A4) and who were diagnosed with two or more cancers (vs. one cancer, Appendix Table A5) or experienced cancer/treatment-related pain (vs. none, Appendix Table A6) in most cancer types. After adjusting for covariates, survivors with cancers of the pancreas, larynx/trachea and lung, bone, melanoma, breast, cervix, uterus, ovary, kidney, brain, thyroid, and leukemia were more likely to have a mobility disability than non-cancer adults (all P <0.05, Figure 1).
Prevalence and Factors of Self-care Disability
Although less common than the prevalence of mobility disability, the prevalence of self-care disability (i.e., having difficulty dressing or bathing) was higher in cancer survivors (7.4% [95% CI: 6.9 to 7.9]) than in non-cancer adults (3.8% [95% CI: 3.8 to 3.9) (Table 1). After adjusting for all covariates, cancer survivors (OR, 1.19 [95% CI: 1.10 to 1.29]) were more likely to have a self-care disability than non-cancer adults (Figure 1).
In contrast to mobility disability, cancer survivors aged <65 years (8.4% [95% CI: 7.6 to 9.2]) were more likely to report a self-care disability than those aged ≥65 years (6.6% [95% CI: 6.0 to 7.2]; OR, 0.68 [95% CI: 0.56 to 0.83]; Table 2 and Appendix Table A3, 7). The prevalence of self-care disability was higher in non-Hispanic Black (11.3% [95% CI: 9.2 to 13.3]), non-Hispanic Asian (7.5% [95% CI: 2.2 to 12.7]), and Hispanic (12.1% [95% CI: 9.6 to 14.7]) survivors than in non-Hispanic Whites (6.2% [95% CI: 5.7 to 6.7]). As was seen for mobility disability, there were significant associations between the prevalence of self-care disability and multiple cancer diagnoses (Appendix Table A8), cancer/treatment-related pain (Appendix Table A9), socioeconomic, lifestyle and health condition factors (Table 2).
Prevalence of self-care disability ranged from 5.6% to 9.2% in common cancers and were highest in cancers of bone (18.9% [95% CI: 10.7 to 26.7]), brain (16.0% [95% CI: 6.1 to 25.8]), and oral cavity & pharynx (9.2% [95% CI: 6.8 to 11.6]) (Table 5). After adjusting for covariates, survivors with cancers of the oral cavity and pharynx, pancreas, bone, cervix, ovary, testis, brain, and leukemia were more likely to have a self-care disability than non-cancer adults (all P <0.05, Figure 1).
Table 5.
Prevalence of Self-care Disability by Cancer Type and Course of Cancer Treatment Among US Adults Aged 18 Years and Older, BRFSS 2017–2022
| Cancer Type | Course of Cancer Treatment |
|||||
|---|---|---|---|---|---|---|
| Overall | Current | Complete | ||||
|
|
|
|
||||
| No. | % (95% CI) | No. | % (95% CI) | No. | % (95% CI) | |
| All | 47768 | 7.4 (6.9 to 7.9) | 5690 | 9.8 (8.2 to 11.4) | 24422 | 6.7 (6.0 to 7.5) |
| Oral Cavity & Pharynx | 442 | 15.3 (7.9 to 22.7) | 41 | 0.8 (0 to 2.1) | 271 | 14.9 (5.9 to 23.9) |
| Head and Neck | 147 | 7.2 (1.7 to 12.7) | NA | NA | 85 | 8.8 (0.6 to 17.1) |
| Digestive System | ||||||
| Esophagus & Stomach | 395 | 9.2 (4.4 to 14.0) | 66 | 8.4 (0 to 19.2) | 175 | 6.2 (0.7 to 11.7) |
| Colon & Rectum | 2559 | 5.8 (4.5 to 7.1) | 231 | 8.7 (4.1 to 13.3) | 1359 | 4.4 (2.8 to 6.1) |
| Liver | 255 | 14.3 (5.7 to 22.9) | 86 | 18.5 (1.7 to 35.3) | 84 | 7.6 (0 to 18.3) |
| Pancreas | 205 | 11.5 (3.7 to 19.4) | 58 | 12.1 (0 to 28.8) | 62 | 2.4 (0 to 5.3) |
| Respiratory System | ||||||
| Larynx/Trachea & Lung | 1426 | 9.2 (6.8 to 11.6) | 289 | 8 (3.4 to 12.5) | 631 | 8.7 (4.6 to 12.8) |
| Musculoskeletal System | ||||||
| Bone | 264 | 18.7 (10.7 to 26.7) | 98 | 12.6 (4.1 to 21.1) | 79 | 14.5 (1.5 to 27.5) |
| Skin | ||||||
| Melanoma | 9281 | 5.9 (4.7 to 7.2) | 577 | 11.5 (5.1 to 17.9) | 4531 | 5.8 (3.5 to 8.2) |
| Breast | 9467 | 5.9 (4.9 to 6.8) | 1536 | 5.5 (3.9 to 7.1) | 5432 | 6.6 (5.1 to 8.0) |
| Reproductive System | ||||||
| Cervix | 2011 | 11.5 (8.4 to 14.6) | 57 | 17.1 (2.7 to 31.5) | 1174 | 15.3 (10.0 to 20.6) |
| Uterus | 1341 | 9.0 (6.7 to 11.3) | 63 | 11 (0 to 22.4) | 737 | 7.4 (4.7 to 10) |
| Ovary | 833 | 12.0 (5.8 to 18.3) | 99 | 10.8 (1.7 to 19.8) | 440 | 6 (2.6 to 9.5) |
| Prostate | 5909 | 5.6 (4.5 to 6.8) | 840 | 10.7 (6.7 to 14.7) | 3171 | 4.7 (3.2 to 6.2) |
| Testis | 306 | 7.6 (2.8 to 12.3) | 9 | 43.1 (0 to 108.7) | 208 | 3.1 (0.3 to 5.9) |
| Urinary System | ||||||
| Bladder | 1316 | 6.3 (4 to 8.5) | 201 | 3.8 (0.5 to 7.1) | 673 | 6.6 (2.8 to 10.4) |
| Kidney | 894 | 10.3 (6.8 to 13.8) | 94 | 21.9 (7.3 to 36.5) | 403 | 7.1 (2.6 to 11.7) |
| Brain | 197 | 16.0 (6.1 to 25.8) | 37 | 14.6 (0.2 to 29.1) | 95 | 11.0 (1.9 to 20.1) |
| Endocrine System | ||||||
| Thyroid | 1398 | 6.0 (4.3 to 7.8) | 104 | 6.1 (1.5 to 10.8) | 804 | 5.2 (2.8 to 7.6) |
| Lymphoma | 1368 | 6.4 (4.3 to 8.5) | 177 | 12.2 (4 to 20.4) | 817 | 4.3 (2.3 to 6.3) |
| Blood | ||||||
| Leukemia | 945 | 9.5 (6.5 to 12.4) | 290 | 10.5 (4.0 to 17.0) | 262 | 6.6 (2.1 to 11.1) |
| Other | 6761 | 8.6 (7.1 to 10.1) | 717 | 14.6 (6.9 to 22.4) | 2902 | 7.2 (5.0 to 9.4) |
All estimates were weighted.
Other cancer types include those not listed above.
Discussion
More than a quarter of US cancer survivors surveyed between 2017 and 2022 reported mobility disability and nearly 10% reported self-care disability. In analyses adjusted for sociodemographic and lifestyle factors and health conditions, the prevalence of both mobility disability and self-care disability were significantly higher in cancer survivors than in non-cancer adults. Several factors were found to be associated with higher prevalence of mobility disability in cancer survivors, including racial/ethnic minority status, higher BMI, physical inactivity, attaining lower levels of educational and/or income, having a history of chronic conditions, and experiencing cancer/treatment-related pain. Similar factors were associated with higher prevalence of self-care disability in cancer survivors; however, younger age was associated with higher odds of self-care disability but lower odds of mobility disability. Finally, patterns of mobility and self-care disabilities varied across cancer types and treatment status.
To our knowledge, our study is one of the first to examine prevalence and cancer-specific patterns of functional disabilities among US cancer survivors. We identified several factors associated with higher prevalence of disability among individuals with a cancer diagnosis. Our findings were consistent with a cross-sectional analysis of 9359 cancer survivors and 105,680 individuals without a history of cancer from the 2015–2019 Medical Expenditure Panel Survey, which indicated that 38.8% of cancer survivors reported at least one functional disability (i.e. hearing, vision, cognition, ambulation, self-care, independent living) vs 16.1% of adults without a cancer history.16 Both analyses also suggested that cancer survivors who were older and unmarried and with lower educational attainment and family income were more likely to report any disability. In addition, although relatively uncommon across all age groups, younger cancer survivors were more likely to report self-care disability compared to older survivors. The etiology of this finding is not clear. Younger cancer survivors may be treated with more aggressive treatment courses, although the lack of treatment-related data in the BRFSS dataset does not allow us to explore this hypothesis. Given that the burden of functional disabilities among younger cancer survivors can diminish their work capabilities, hinder their ability to care for themselves and others and increase societal and economic costs,4 this finding requires additional evaluation in other data sets.
We also found a higher prevalence of functional disabilities among non-Hispanic black and Hispanic survivors. These findings are consistent with prior studies showing racial/ethnic minorities were disproportionally affected by cancer-induced physical impairments and disabilities.6,17,18 A study using nationally representative data found that the prevalence of functional limitation among US cancer survivors increased from 57% in 1999 to 70% in 2018, with the most significant increases observed in Hispanic (25.1%) and Black (19.4%) survivors.6 Given that functional disabilities in cancer survivors impact their ability to care for themselves and their families and to remain gainfully employed, the increased prevalence of functional limitations in racial/ethnic minority cancer survivors accelerates financial toxicities in this vulnerable population,19,20 highlighting the importance of developing feasible interventions to prevent functional disabilities..
Our study also demonstrated associations between functional disability and lifestyle factors, as well as comorbidities. Although there are established bidirectional relationships between physical inactivity, obesity, comorbidities and functional disabilities in the general population,21 less is known about the relationship between these factors and disability in cancer survivors. Our findings showed that obesity, inactivity, smoking, and comorbid conditions were associated with higher odds of functional disabilities. The coexistence of unhealthy lifestyle behaviors and comorbidities and disabilities may further decrease quality of life and long-term survival in cancer survivors.22–24
Based on our estimates and the number of cancer survivors living in the US,2 it is expected that 50.2 million and 1.3 million American cancer survivors have mobility and self-care disability. In conjunction with optimizing therapeutic regimens to mitigate the side effects that induce physical limitations,25 lifestyle interventions emerge as a promising approach to preserve physical function and prevent cancer-related disability.3 Cumulative evidence has demonstrated that exercise during cancer treatment reduces treatment-related side effects, such as fatigue, chemotherapy-induced peripheral neuropathy and musculoskeletal impairments, helping to prevent decline in physical function.26 Guidelines from the American Society of Clinical Oncology (ASCO)27 and American College of Sports Medicine (ACSM)28 recommended that aerobic and resistance training exercise should become a standard part of cancer treatment for malignancies being treated with curative intent to enhance physical functioning and many aspects of quality of life. Nevertheless, the management of functional limitations should be multimodal approaches to prevent cancer-related disabilities.
There are several limitations of our study. Our study was cross-sectional; thus, it is not possible to determine whether disability was present at the time of cancer diagnosis or occurred as a result of cancer treatment. A better understanding of the impact of cancer treatment on disability will be important in identifying the populations most likely to benefit from interventions to preserve physical function after cancer diagnosis. Additionally, functional disability was assessed using self-reported questions from the American Community Survey. Although this instrument is well-validated and has been implemented in several US surveillance systems to estimate the prevalence of disabilities in the US population, 13,29 it is possible that individuals over or under-reported functional capacity. Cancer-related factors, such as cancer type and treatment history, were also self-reported. Finally, BRFSS did not collect information on clinical and pathological staging of cancer and could not differentiate between primary cancers and metastatic disease. Therefore, it is possible that individuals who reported having been diagnosed with more than one cancer, and individuals who reported being diagnosed with cancers of the bone or other sites typical of metastases, could have represented a population of individuals living with advanced cancer.30 Given that disability would be expected to be more common in advanced cancer, it may have increased the likelihood of disability associated with these diagnoses.
Conclusion
In this population-based study of US adults, cancer survivors exhibited a higher prevalence of mobility and self-care disabilities compared to non-cancer individuals. During 2017–2022, over a quarter of US cancer survivors reported mobility disability, and nearly 10% reported self-care disability, with patterns varying across cancer types. Mobility and self-care disabilities were more prevalent in those undergoing active treatment and those with cancer/treatment related pain. Racial/ethnic minorities, along with underserved groups and individuals with unhealthy lifestyles or comorbidities, were notably more impacted by functional disabilities, underscoring the need for targeted disability prevention efforts.
Supplementary Material
Context Summary.
Key Objective
To define the prevalence, factors, and cancer-specific patterns of functional disabilities among US cancer survivors.
Knowledge Generated
In this population-based study, US cancer survivors exhibited a higher prevalence of mobility and self-care disabilities compared to non-cancer individuals. During 2017–2022, over a quarter of US cancer survivors reported mobility disability, and nearly 10% reported self-care disability, with patterns varying across cancer types. Mobility and self-care disabilities were more prevalent in those undergoing active treatment and those with cancer/treatment related pain. Racial/ethnic minorities, underserved groups and individuals with unhealthy lifestyles or comorbidities, were notably more impacted by functional disabilities.
Relevance (written by Dr. Smita Bhatia)
These findings highlight the need to increase patient and provider awareness regarding the presence of functional disabilities and the need for developing strategies for targeted disability prevention and early detection/ management.
Funding:
Cao is supported by the U.S. National Cancer Institute grant 5T32CA092203.
Role of sponsor:
The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Footnotes
Competing interests:
The authors have no conflicts to disclose.
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