Physical performance measures for predicting outcome in cancer patients: a systematic review

<b>Background:</b> Decision making regarding cancer treatment is challenging and there is a need for clinical parameters that can guide these decisions. As physical performance appears to be a reflection of health status, the aim of this systematic review is to assess whether physical performance tests (PPTs) are predictive of the clinical outcome and treatment tolerance in cancer patients. <b>Methods:</b> A literature search was conducted on 2 April 2015 in the electronic databases Medline and Embase to identify studies focusing on the association between objectively measured PPTs and outcome. No limitations in language or publication dates were applied. <b>Results:</b> The search retrieved 9680 articles, 16 publications were included involving 4187 patients with various cancer types and different treatments. Reported median or mean age varied from 58 to 78 years. Nine studies used the Timed Up &amp; Go (TUG) test, five the Short Physical Performance Battery (SPPB) and five studies focused on gait speed. Poorer TUG, SPPB and gait speed outcome were associated with decreased survival. TUG, SPPB and gait speed were also associated with treatment-related complications. Furthermore, two studies reported an association between poorer TUG and SPPB outcome with higher rates of functional decline. <b>Conclusion:</b> PPTs appear to show a significant correlation with survival and these tests could be used as a prognostic tool, particular for older adult patients. A less explicit correlation for treatment-related complications and functional decline was also found. To optimize decision making, future research should focus on developing and validating individualized treatment algorithms that incorporate PPTs in addition to cancer- and treatment-related variables.

<b>研究背景：</b> 癌症治疗决策颇具挑战性，亟需可指导此类决策的临床参数。鉴于身体机能表现可反映健康状态，本系统综述旨在评估身体机能测试（Physical Performance Tests，PPTs）能否预测癌症患者的临床结局与治疗耐受性。<b>研究方法：</b> 本研究于2015年4月2日在Medline、Embase电子数据库中开展文献检索，以筛选聚焦于客观测量的PPTs与临床结局之间关联的相关研究。本次检索未设置语言与发表时间限制。<b>研究结果：</b> 本次检索共获取9680篇文献，最终纳入16项研究，涉及4187名罹患多种癌症类型且接受不同治疗方案的患者。纳入研究报告的患者年龄中位数或均值介于58至78岁之间。其中9项研究采用计时起立行走测试（Timed Up & Go，TUG），5项采用简短身体机能测试量表（Short Physical Performance Battery，SPPB），另有5项研究聚焦于步速评估。较差的TUG、SPPB及步速测试结果与生存率降低显著相关。TUG、SPPB及步速同样与治疗相关并发症存在关联。此外，有2项研究报告显示，较差的TUG与SPPB测试结果与更高的功能衰退发生率相关。<b>研究结论：</b> PPTs与患者生存率存在显著相关性，此类测试可作为预后工具，尤其适用于老年患者。本研究同时发现，PPTs与治疗相关并发症及功能衰退的相关性则相对较弱。为优化治疗决策制定，未来研究应聚焦于开发并验证纳入PPTs以及癌症与治疗相关变量的个体化治疗算法。