Prevalence of Functional Limitations in U.S. Cancer Survivors

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In a study reported in a research letter in JAMA Oncology, Patel et al found that the prevalence of self-reported functional limitations in U.S. cancer survivors increased between 1999 and 2018.

Study Details

The analysis included adults in the 1999 to 2018 National Health Interview Survey (NHIS) with a self-reported history of cancer. Functional limitation was defined as self-reported difficulty performing any of 12 routine physical or social activities without assistance. Analysis included trends in numbers of prevalent cases of functional limitation and risk-adjusted period prevalence of functional limitation, accounting for age, sex, self-reported race and ethnicity, education, insurance, income, survey year, region, cancer site, and time since diagnosis. Changes in adjusted prevalence over the study period were stratified by clinicodemographic factors.

Key Findings

A total of 51,258 cancer survivors were identified, representing a weighted population of approximately 178.8 million from 1999 to 2018. Among survivors, 60.2% were women and 55.4% were aged ≥ 65 years.

A total of 3.6 million weighted survivors reported functional limitation in 1999; the number increased to 8.2 million in 2018, yielding a 2.25-fold increase. The number of weighted limitation-free survivors increased 1.34-fold from 1999 to 2018. By comparison, the number of cancer-free individuals with functional limitation increased 1.6-fold from 1999 to 2018.

The adjusted prevalence of functional limitation among survivors increased from 57.0% in 1999 to 70.1% in 2018—an absolute increase of 13.1% (95% CI = 12.5%–13.6%, P < .001 for trend). Absolute increases from 1999 to 2018 were greatest among Hispanic survivors (25.1%), Black survivors (19.4%), and survivors aged 55 to 64 years at diagnosis (17.2%). Absolute increases were 14.4% and 14.2% among survivors aged 18 to 44 years and 45 to 54 years, and 9.4% and 8.1% among those aged 65 to 74 years and ≥ 75 years. Over the study period, the adjusted prevalence of functional limitation was highest among survivors of pancreatic (80.3%) and lung (76.5%) cancers, and lowest for survivors of melanoma (62.2%), breast cancer (61.8%), and prostate cancer (59.5%).  

As stated by the investigators, “The number of cancer survivors with self-reported functional limitation has more than doubled during the past 20 years, with relatively less growth in the number of limitation-free survivors. The 70% prevalence of functional limitation among survivors in 2018 is nearly twice that of the general population…. These findings may reflect changes in treatment patterns for both early-stage cancers and late-stage cancers. We believe factors other than population aging are likely associated with increasing functional limitations, since survivors [younger than age 65] experienced the greatest increases.”

Vishal R. Patel, BS, of Dell Medical School, The University of Texas at Austin, is the corresponding author for the JAMA Oncology article.

Disclosure: For full disclosures of the study authors, visit

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