Factors associated with functional status among older women with ovarian cancer

Background: Women aged 65+ account for nearly half of new ovarian cancer diagnoses. This patient group faces a substantial risk of declining functional status, i.e., the capability to carry out essential daily activities necessary for basic needs and health, such as dressing, bathing, toilet use, and eating. For this patient group, maintaining functional independence is a top priority. However, factors influencing functional status in older women with ovarian cancer remain poorly understood. This study aimed to identify demographic and clinical factors associated with functional status in this vulnerable population. Methods: We utilized data from the Minimum Data Set (MDS), which provides standardized functional assessments for U.S. nursing home residents. MDS data were linked with SEER-Medicare to capture cancer diagnoses and medical histories. The cohort included 6,257 women with primary invasive epithelial ovarian cancer diagnosed at age 65+ between 2000-2019. Functional status was quantified using a validated Activities of Daily Living (ADL) scale ranging from 0-28, with higher scores indicating greater dependency. A linear mixed-effect model was fit to identify factors associated with functional status during the first year after diagnosis, while accounting for repeated measures. Variables included age at diagnosis, Charlson Comorbidity Index, tumor stage, histotype, race/ethnicity, and Medicaid enrollment (as a proxy for socioeconomic status). Results: Median age at diagnosis was 79 years (interquartile range 74-84 years) with most diagnosed at distant stage (74%). Older age was associated with higher ADL scores (mean difference [MD]=0.07 per one year increase in age, 95% confidence interval [CI] 0.05-0.09, p<0.01). Other factors associated with higher ADL scores included: higher comorbidity (MD=0.41 per unit increase in Charlson Comorbidity Index, 95% CI 0.33-0.50, p<0.01), later tumor stage (distant vs. localized stages: MD=1.38, 95% CI 0.80-1.95, p<0.01) and non-serous histotype (non-serous vs. serous: MD=0.90, 95% CI 0.63-1.18, p<0.01). Higher ADL scores were also observed for non-White vs. White women (MD=1.95, 1.45, 1.14 for Black, Hispanic, and Asian/Pacific Islander, respectively, all p<0.01) and Medicaid-enrolled patients vs. non-enrolled (MD=0.65, 95% CI 0.11-1.18, p=0.02). Conclusions: Older age, higher comorbidity, later tumor stage, non-serous histotype, non-White race/ethnicity, and Medicaid enrollment are independently associated with increased functional dependency in older women with ovarian cancer. These findings suggest both biological and socioeconomic drivers of functional decline. Targeted supportive care is needed to mitigate functional decline, particularly for women with advanced disease, comorbidities, minority backgrounds, and low socioeconomic status.