INTRODUCTION: We aimed to systematically evaluate the effects of exercise interventions on quality of life in older adults with cancer and to explore the dose-response relationships associated with key exercise prescript...INTRODUCTION: We aimed to systematically evaluate the effects of exercise interventions on quality of life in older adults with cancer and to explore the dose-response relationships associated with key exercise prescription parameters. MATERIALS AND METHODS: We conducted searches of PubMed, Embase, Web of Science, Scopus, and the Cochrane Library; standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were performed to identify potential effect modifiers, and dose-response models were constructed to quantify the relationship between exercise dose and quality-of-life outcomes. RESULTS: A total of 32 studies involving 2557 older adults with cancer were included. Meta-analysis demonstrated that exercise interventions significantly improved quality of life (SMD = 0.27, 95% CI: 0.14-0.41). Subgroup analyses suggested that intervention characteristics were associated with differential effects, with relatively greater improvements observed in studies with intervention durations of 8-12 weeks (SMD = 0.37, 95% CI: 0.19-0.56, p = 0.003), a frequency of three sessions per week (SMD = 0.36, 95% CI: 0.18-0.54, p < 0.001), and session durations of less than 45 min (SMD = 0.39, 95% CI: 0.23-0.55, p < 0.001). Dose-response analysis indicated that the effect peaked at an overall weekly exercise volume of approximately 962.94 MET·min/week (Hedges' g = 0.41, 95% CI: 0.18-0.64). DISCUSSION: Exercise interventions significantly improve quality of life in older adults with cancer, with a weekly exercise volume of approximately 962.94 MET·min/week associated with greater improvements. Although exercise frequency and other parameters are related to quality of life, current evidence remains insufficient to support a standardized prescription, and individualized approaches should be considered.
Noronha V, Rao A, Pillai A
… +28 more, Ramaswamy A, Gota V, Mailankody S, Pushpam D, Sehgal A, Banerjee J, Kapoor A, Kumar A, Shah M, Menon N, Narasimhan P, Mahajan P, Timmanpyati S, Chitre A, Sonkusare L, Mahajan S, Daptardar A, Vagal M, Mishra BK, Anne S, Gupta T, Roy M, Shetty N, Kumar A, Mittal K, Mahajan V, Sharma S, Prabhash K
Liposits G, André T, Aparicio T
… +13 more, Montroni I, Taieb J, Gallois C, Van Cutsem E, Ducreux M, Pfeiffer P, Lonardi S, Beets GL, Haustermans K, Starling N, Prager GW, Folprecht G, Papamichael D
INTRODUCTION: Endocrine therapies (ETs) and CDK4/6 inhibitors are cornerstone treatments for hormone receptor-positive (HR+) breast cancer, but their association with cognitive dysfunction remains poorly characterized. G...INTRODUCTION: Endocrine therapies (ETs) and CDK4/6 inhibitors are cornerstone treatments for hormone receptor-positive (HR+) breast cancer, but their association with cognitive dysfunction remains poorly characterized. Given the clinical significance of treatment-related cognitive impairment, we aimed to systematically assess cognitive adverse events (AEs) associated with ETs and CDK4/6 inhibitors using real-world pharmacovigilance data. MATERIALS AND METHODS: The FDA Adverse Event Reporting System (FAERS) database (2004-2024) was analyzed, excluding confounders (e.g., pre-existing cognitive disorders, concomitant neurotoxic medications). Reporting odds ratios (RORs) identified significant AEs; Time-to-onset analysis and Kaplan-Meier curves evaluated temporal patterns. Subgroup analyses compared monotherapies (aromatase inhibitors, SERMs, GnRHa, CDK4/6 inhibitors) and combination regimens. RESULTS: Among 68,832 ET/CDK4/6 inhibitor reports, 2827 cognitive AEs (4.11%) were identified. Memory impairment (31.98%), confusional state (16.98%), and amnesia (9.98%) predominated. Nine neuropsychiatric AEs showed significant associations, with SERMs having the highest risk (ROR = 2.12, 95% CI:1.76-2.55). Median time-to-onset was 88 days (IQR:1-2231); 50% occurred within three months. Abemaciclib monotherapy had the shortest onset (36 days), tamoxifen monotherapy the longest (496 days). Affected patients were primarily older (>65 years: 60.28%) and female (98.37%); most reports involved CDK4/6 inhibitor monotherapy (46.34%) or AI combinations (28.48%). Fatal outcomes occurred in 5.8% of cases. DISCUSSION: This study delineates the spectrum, timing, and risk profiles of cognitive dysfunction linked to ETs and CDK4/6 inhibitors, highlighting the need for proactive monitoring, particularly in older patients and combination regimens. While limitations inherent to FAERS data apply, these hypothesis-generating findings provide a foundation for mechanistic research and clinical risk stratification.
INTRODUCTION: Older adults with cancer are at greater risk of experiencing drug therapy problems (DTPs), often related to multiple comorbidities, advanced age, and cancer treatments. Increasing evidence demonstrates the...INTRODUCTION: Older adults with cancer are at greater risk of experiencing drug therapy problems (DTPs), often related to multiple comorbidities, advanced age, and cancer treatments. Increasing evidence demonstrates the value of a pharmacist in geriatric oncology clinics, but little information exists on their practical integration. Our objective is to evaluate the logistics and impact of a pharmacist review of patients referred to a geriatric oncology clinic at an academic cancer centre. MATERIALS AND METHODS: Starting January 2023, a one-year quality improvement pilot project integrated a pharmacist review of patients referred to the Older Adults with Cancer Clinic (OACC) at Princess Margaret Cancer Centre, Toronto, Canada. Eligibility criteria included: no existing best possible medication history (BPMH), taking ≥5 medications, plan for or undergoing systemic cancer therapy, or if requested by the OACC team. The BPMH, pharmacist assessment, and DTPs/recommendations were documented in the institution's electronic health record and flagged for the OACC team. Key outcomes included DTPs identified, time required by the pharmacists, and lessons learned. Interprofessional meetings were held every 2 to 3 months to review progress and provide constructive feedback. Descriptive and inferential analyses were performed. RESULTS: Over 49 weeks, the pharmacists reviewed 205 patients, averaging 4 patients per 7-h shift each week. Patients had a mean age of 81 years (SD = 6.6), 51.7% were male, were taking a mean 11.5 medications (SD = 4.8), and 73.7% patients were pre-treatment with a plan for systemic therapy. The mean pharmacist review time was 103.1 (SD = 60.3) minutes per patient. A total of 300 DTPs were identified during the one-year period and the most common DTP was adverse drug reaction. The majority of DTPs (65%) identified were accepted/acknowledged by the OACC geriatricians. Challenges that the pharmacists encountered included: determining which patients to prioritize, obtaining a BPMH remotely, and having only 1 day a week to complete review. DISCUSSION: This pilot project demonstrated that a pharmacist-integrated model for conducting BPMHs for a geriatric oncology clinic is feasible and clinically valuable. The pharmacists identified many DTPs, including those related to cancer therapies, contributing to safer and more informed treatment planning.
INTRODUCTION: Improvements in cancer survival are happening in the context of an ageing population who may experience age-related complications from cancer therapies and unique needs in cancer survivorship. The long-term...INTRODUCTION: Improvements in cancer survival are happening in the context of an ageing population who may experience age-related complications from cancer therapies and unique needs in cancer survivorship. The long-term survivorship trajectory in terms of function, participation and associated health indicators is poorly documented outside of the United States (U.S.). The overall aim of this study is to examine perceived physical performance limitations, participation restrictions and associated objective metrics among an Irish cohort of cancer survivors aged >50 years. MATERIALS AND METHODS: A sub-cohort of data from Wave 1 of The Irish Longitudinal Study of Ageing (TILDA) (collected October 2009-February 2011) were analysed. Self-reported physical performance and participation restrictions, and related objective measures (timed-up-and-go, handgrip strength, dual manual task, gait speed, heel ultrasound T-scores and heel ultrasound stiffness index), were examined in those diagnosed with cancer <5 years ago (n = 157), >5 years ago (n = 208) and those without a history of cancer (n = 5526). Data were analysed using multivariate regression models using appropriate survey weights to reflect population estimates. RESULTS: Recent cancer survivors were 1.81 (95% CI: 1.08, 3.06) times more likely to report at least one physical performance limitation than individuals without a history of cancer. Furthermore, long-term survivors exhibited a higher risk of severe cumulative physical performance limitations (OR = 3.05, 95% CI: 1.31, 7.12) compared to individuals without a history of cancer. In multivariate analysis, osteoporosis risk was twice as high in long-term cancer survivors as assessed by both heel ultrasound T-scores (RRR 2.26 (95% CI: 1.29, 3.94)) and heel ultrasound stiffness index (RRR 2.21 (95% CI: 1.20, 4.08) compared to individuals without a history of cancer. Objective measures of physical performance were similar between groups. DISCUSSION: The findings indicate that, despite maintaining independent living, community-dwelling, Irish cancer survivors face elevated risks of physical performance limitations including cumulative burden of limitations, compared to community-dwelling adults without a history of cancer. Functional impairments are reflected in bone density metrics, signalling a cohort at risk of falls, fracture and loss of independence.
INTRODUCTION: Advances in breast cancer treatments have reduced acute toxicities, but there can be lingering side effects that impact quality of life (QoL) and function years after treatment completion. Understanding the...INTRODUCTION: Advances in breast cancer treatments have reduced acute toxicities, but there can be lingering side effects that impact quality of life (QoL) and function years after treatment completion. Understanding these long-term sequelae in younger as compared older survivors under a variety of treatment scenarios may facilitate early symptom-moderating interventions. MATERIALS AND METHODS: This is a single-arm observational study of women who are three or more years post primary treatment for early breast cancer (stage I-III). All study participants were recurrence-free and without active malignancies at the time of study recruitment when they completed a variety of patient-reported outcome (PRO) surveys. PROMIS-Global (Patient-Reported Outcomes Measurement Information System) Physical Function and PROMIS-Global Mental Health were the primary outcome variables. RESULTS: The cohort included 122 women under age 65 and 125 women age 65 or older at the time of follow-up. Younger survivors were more likely to have stage II-III disease (p = .05), undergo mastectomy (p < .0001), and receive chemotherapy (p = .0009). Older survivors were more likely to receive radiation (p = .004) and endocrine therapy (p = .02). At follow-up, older survivors reported better mental health (p = .003), less anxiety (p = .007), less stress (p = .002), fewer endocrine symptoms (p ≤0.0001), and higher social/family well-being (p = .03). Older survivors also reported more severe neurotoxicity (p = .002) and worse aging-associated arthralgia (p = .05) compared to the younger women. DISCUSSION: Long-term QoL and function outcomes differ by age for early breast cancer survivors. The findings of this study highlight the need for age-specific monitoring and supportive care strategies to promote long-term quality of life and function in breast cancer survivors of all ages.
This manuscript is expected to be considered as a "Research Letter"; therefore, an Abstract is not mandatory.This manuscript is expected to be considered as a "Research Letter"; therefore, an Abstract is not mandatory.
INTRODCUTION: The phase 3, randomized trial BRUIN CLL-321 assessed the safety and efficacy of pirtobrutinib versus investigators choice of idelalisib plus rituximab (IdelaR) or bendamustine plus rituximab (BR) in patient...INTRODCUTION: The phase 3, randomized trial BRUIN CLL-321 assessed the safety and efficacy of pirtobrutinib versus investigators choice of idelalisib plus rituximab (IdelaR) or bendamustine plus rituximab (BR) in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) previously treated with a covalent BTK inhibitor. BRUIN CLL-321 showed significantly improved progression-free survival with pirtobrutinib compared to IdealR/BR. We report secondary endpoints including time to worsening (TTW) of CLL/SLL-related symptoms and physical function (PF). MATERIALS AND METHODS: Patients with relapsed/refractory CLL/SLL who received at least one prior cBTKi were enrolled in BRUIN CLL-321. Exploratory endpoints were evaluated using mixed models for repeated measures analysis for within- and between-group differences. Patient-reported outcomes (PROs) were collected every 4 weeks during study treatment through week 25 on both arms. TTW was evaluated using log rank test and Cox proportional hazards model. The statistical testing of PRO endpoints was not type-1 error controlled and thus descriptive in nature. RESULTS: A total of 119 patients were randomized to each treatment arm (N = 238). Median TTW in CLL/SLL-related symptoms (HR,0.972 [95%CI, 0.461-2.048; p = 0.89) and PF (HR, 0.590 [95%CI, 0.262-1.326]; p = 0.33) was not reached in either treatment arm. Pirtobrutinib demonstrated clinically meaningful improvements from baseline in CLL/SLL-related symptoms, PF, and fatigue at all post-baseline assessments (least squares [LS] means change ranged from -7.0 to -11.8, +5.4 to +8.9, and - 7.0 to -12.7, respectively). Comparing between groups, CLL/SLL-related symptoms were clinically meaningfully lower in the pirtobrutinib group versus IdelaR/BR at Week 9 (LSM,-7.3 [standard error (SE), 2.2]), Week 13 (LSM,-6.7 [SE, 2.3]), Week 17 (LSM,-4.6 [SE, 2.3]), and Week 21 (LSM,-7.0 [SE, 2.3]). Patients receiving pirtobrutinib reported better PF versus IdelaR/BR at Weeks 13 (LSM,5.6 [SE, 2.4]) and 21 (LSM,5.9 [SE, 2.5]). Patients receiving pirtobrutinib also reported clinically meaningful lower fatigue versus IdelaR/BR at Week 9 (LSM,-9.0 [SE, 2.9]), Week 13 (LSM,-6.7 [SE, 3.0]), and Week 21 (LSM,-6.9 [SE, 3.1]). DISCUSSION: These analyses demonstrate clinically meaningful improvements for pirtobrutinib at all post-baseline assessments for CLL/SLL-related symptoms, PF, and fatigue. Consistent benefit was seen in CLL/SLL-related symptoms, PF, and fatigue with pirtobrutinib versus IdelaR/BR, with most PRO assessments meeting clinically meaningful differences between groups.
INTRODUCTION: Immune checkpoint inhibitors (ICI) have transformed the treatment landscape for triple-negative breast cancer (TNBC), but their efficacy in older adults remains unclear. The objective of this systematic rev...INTRODUCTION: Immune checkpoint inhibitors (ICI) have transformed the treatment landscape for triple-negative breast cancer (TNBC), but their efficacy in older adults remains unclear. The objective of this systematic review is to evaluate the efficacy of ICI in patients with TNBC aged ≥65 years. MATERIALS AND METHODS: We conducted a systematic review of randomized controlled trials (RCTs) between January 2013 and September 2023 using searches of Medline, Embase, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. RESULTS: Eighteen full-text articles representing 11 unique RCTs were identified. Only four RCTs reported efficacy outcomes for patients ≥65 years: KEYNOTE 355, KEYNOTE 522, IMpassion130, and IMpassion131. Across these trials, 602 of 3215 patients (18.7%) were 65 and older. The overall risk of bias was low to intermediate, but heterogeneity in trial design and endpoints precluded meta-analysis. Pembrolizumab, the only FDA-approved ICI in TNBC, showed a nonsignificant trend toward improved pathological complete response and event-free survival among older adults with early-stage TNBC (KEYNOTE-522). In the metastatic setting, pembrolizumab may improve overall survival in older patients with PD-L1 combined positive score ≥ 10 (KEYNOTE-355). All studies enrolled few older patients, and none prespecified age-stratified analyses. DISCUSSION: These findings highlight a major evidence gap and underscore the need for further research evaluating ICI outcomes in older adults with TNBC.
INTRODUCTION: The intermediate-risk category of the Cancer and Aging Research Group (CARG) toxicity score (6-9) is heterogeneous and complicates treatment decisions in older adults receiving chemotherapy. The CARG score...INTRODUCTION: The intermediate-risk category of the Cancer and Aging Research Group (CARG) toxicity score (6-9) is heterogeneous and complicates treatment decisions in older adults receiving chemotherapy. The CARG score is a validated geriatric assessment tool that predicts chemotherapy-related toxicity using clinical, laboratory, and functional variables. However, the broad intermediate-risk group limits its clinical applicability. We aimed to validate a simplified binary classification (CARG <8 vs ≥8), termed the CARG-8 score, as a pragmatic tool for toxicity risk stratification. MATERIALS AND METHODS: This two-phase multicenter study included a retrospective cohort of 206 patients aged ≥65 years treated with cytotoxic chemotherapy between 2019 and 2023, and a prospective cohort of 175 patients enrolled between 2022 and 2025. Patients were categorized as low-risk (CARG <8) or high-risk (CARG ≥8). The cutoff of 8 was determined using receiver operating characteristic (ROC) curve analysis and Youden's J index to optimize prediction of grade 3+ toxicity. The primary endpoint was severe (3+) toxicity; logistic regression evaluated statistical associations. The effect of upfront chemotherapy dose reduction (<90% of standard) was also explored among high-risk patients. RESULTS: In the retrospective cohort, high-risk patients experienced higher rates of grade 3+ toxicity (41.0% vs 24.5%; OR 2.14, P = 0.02), treatment delays (50% vs 27%; OR 2.66, P = 0.001), and dose reductions (38% vs 16%; OR 3.21, P < 0.001). Findings were confirmed in the prospective cohort, with greater severe toxicity (29% vs 14%; OR 2.58, P = 0.02) and delays (39% vs 14%; OR 4.03, P < 0.001). Among high-risk patients, upfront dose reduction markedly decreased severe toxicity both retrospectively (23% vs 71%; OR 0.13, P < 0.001) and prospectively (16% vs 75%; P < 0.001). Multivariable analysis identified CARG ≥8 as the only independent predictor of grade 3+ toxicity (OR 4.20, P = 0.01). DISCUSSION: A CARG cutoff of 8 effectively stratifies toxicity risk and identifies older adults who may benefit from initial dose attenuation, supporting its use for risk-adapted chemotherapy in geriatric oncology.
INTRODUCTION: Advancing age is associated with declining physiological reserves and increasing vulnerabilities. This can have an impact on the ability to tolerate or complete cancer treatments. Increasingly, geriatric as...INTRODUCTION: Advancing age is associated with declining physiological reserves and increasing vulnerabilities. This can have an impact on the ability to tolerate or complete cancer treatments. Increasingly, geriatric assessments are recommended for older adults with cancer. Comprehensive medication reviews are an essential component of geriatric assessments. Integration of pharmacists in multidisciplinary oncology teams helps to optimize medication use. Little is known about the knowledge and skills required by pharmacists working with older adults with cancer to optimize medication. The scoping review aimed to explore the evidence for educational needs of pharmacists in optimizing medication in older adults with cancer. MATERIALS AND METHODS: We conducted a scoping review based on Arksey and O'Malley and Levac methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scoping review guidelines. A review of seven databases: Embase, Medline, Scopus, Web of Science, CINAHL, ERIC, and Cochrane Library identified original studies. The quality of papers was assessed using the Mixed Method Appraisal Tool. RESULTS: From 313 titles and abstracts identified, 49 full texts were screened and nine were included in the analysis. Training needs for community pharmacists, oncology pharmacists and pharmacists caring for older adults were identified. Competencies for developing pharmacists' knowledge and skills were identified. None of the studies evaluated impact of training on health outcomes. Overall, the methodological quality of included studies was good. DISCUSSION: Under- and post-graduate pharmacist education does not include specific training to optimize medication in older adults with cancer. There is an urgent need to upskill oncology pharmacists to support medication optimization in this population. Educators, pharmacy professional bodies and regulatory bodies are encouraged to ensure pharmacists have appropriate training and competencies to meet the complex needs of older adults with cancer.
INTRODUCTION: Cancer rehabilitation and exercise services (CaRES) improve physical function and survival. Yet, CaRES remain underutilized by survivors, despite the availability of ≥2000 CaRES nationwide. To date, CaRES r...INTRODUCTION: Cancer rehabilitation and exercise services (CaRES) improve physical function and survival. Yet, CaRES remain underutilized by survivors, despite the availability of ≥2000 CaRES nationwide. To date, CaRES referrals have originated primarily from oncologists. Primary care providers (PCPs) are an untapped potential referral source, particularly for older cancer survivors (≥65 years) who often have long-term PCP relationships. This study aimed to explore multi-level perspectives on primary care referrals to CaRES and co-create a prototype referral process. MATERIALS AND METHODS: Individual semi-structured interviews were conducted with three groups: (1) older cancer survivors (≥65 years), (2) PCPs, and (3) CaRES directors. Semi-structured interview guides were developed with guidance from the Pragmatic Robust Implementation and Sustainability Model (PRISM) to understand factors that could influence PCP referrals to CaRES. Two rounds of iterative feedback on a prototype CaRES referral process were obtained. Interviews were recorded, transcribed, and deidentified. Transcripts were analyzed using rapid matrix analysis with domains mapped onto PRISM. After the completion of all interviews, the final prototype referral process was distributed to all participants for member-checking. RESULTS: PCP-initiated CaRES referrals were viewed as appropriate by survivors (n = 5), PCPs (n = 6), and CaRES directors (n = 7). However, PCPs were not aware of CaRES, "…you'd have to make sure that providers are aware of it… I wasn't aware of it," (3-PCP). Two key needs for the referral process were: (1) initial PCP education about CaRES and (2) embedding the referral process into existing workflows. CaRES directors stated that successful referral processes to date have required tailoring to individual clinics, "We…discuss what their referral process is internally, and how we can fit this referral with what's already going on in their workflow" (11-Director). Iterative feedback on the referral process resulted in a wireframe prototype of a clinical decision support tool for CaRES referrals. DISCUSSION: The PCP-initiated CaRES referral process was of interest to cancer survivors, PCPs, and CaRES directors, but will require tailoring to individual clinic workflows. PCP-initiated CaRES referrals may expand the reach of CaRES by providing another opportunity, in addition to the oncology care team, for patients to learn about and connect with CaRES.
INTRODUCTION: Treatment decisions are influenced by disease and patient related factors, yet little is known about how older patients evaluate these decisions after treatment. This study explores how older adults with ca...INTRODUCTION: Treatment decisions are influenced by disease and patient related factors, yet little is known about how older patients evaluate these decisions after treatment. This study explores how older adults with cancer reflect on the treatment decision-making (TDM) process and whether they considered the treatment 'worth it', capturing perspectives before treatment and three months after TDM. The findings aim to inform person-centered treatment decision-making in geriatric oncology. MATERIALS AND METHODS: We conducted a qualitative study using semi-structured interviews at two timepoints: pre-treatment (after the decision but before treatment) and three months post-treatment. Patients were eligible for inclusion if they were over 70 years of age and diagnosed with a solid malignancy requiring a potentially surgical treatment decision. A thematic content analysis was performed. RESULTS: We performed 16 semi-structured interviews among eight patients with a median age of 76.6 (range 71-81). Six themes were identified across the pre-treatment, treatment, and post-treatment phases, including navigation of personal and (social) contexts, alignment of treatment goals with personal priorities and values, the decision-making conversation, treatment-related aspects, post-treatment reflexivity on goals and preferences, and an overarching theme concerning communication and interaction with healthcare professionals. DISCUSSION: How older patients reflected on the dynamic process of treatment decision-making and if they perceived the treatment to be worthwhile is a multidimensional process and influenced by context, values and priorities, the decision-making process, the treatment effects and communication. Reflections can be dominated by severe outcomes when a tipping point is reached where people can no longer return to their meaningful activities, underscoring the importance of explicitly discussing what matters to patients during TDM.
INTRODUCTION: Locomotive syndrome (LS) is characterized by impaired mobility from musculoskeletal dysfunction and is associated with future disability and mortality. Its perioperative relevance in gastrointestinal (GI) c...INTRODUCTION: Locomotive syndrome (LS) is characterized by impaired mobility from musculoskeletal dysfunction and is associated with future disability and mortality. Its perioperative relevance in gastrointestinal (GI) cancer remains unclear. This study aimed to determine if preoperative LS and its severity predict diminished postoperative physical function at discharge following GI cancer surgery. MATERIALS AND METHODS: This single-center, retrospective cohort study included adults undergoing elective, curative-intent surgery for GI malignancies between February 2023 and June 2025 at a university hospital. Preoperative LS was assessed using the Japanese Orthopaedic Association test battery, categorizing patients into stages 0-3 (LS absent vs. present). Physical function was evaluated using various measures. The primary outcome was postoperative function at discharge, with change scores (Δ) calculated from baseline. Group comparisons and analysis of covariance (ANCOVA) models were used to evaluate Δ6-min walk distance (6MWD), Δgrip strength, ΔTimed Up-and-Go (ΔTUG), and Δskeletal muscle mass index (ΔSMI), while adjusting for age, sex, body mass index, the pre- to postoperative assessment interval, and the corresponding preoperative value. An interaction term was included to test LS × preoperative function. RESULTS: Of 339 patients screened, 75 were included in the final analysis. Preoperatively, 19 patients were classified as (LS) stage 0, 14 as stage 1, 14 as stage 2, and 28 as stage 3. In ANCOVA for change in Δ6MWD, LS status was independently associated with Δ6MWD. A significant LS × preoperative 6MWD interaction indicated that the effect of LS on postoperative endurance loss differed according to baseline walking capacity. For grip strength and TUG, neither LS status nor LS × baseline interactions were significant, while for SMMI, baseline value and sex were significant predictors. DISCUSSION: Preoperative LS modifies the association between baseline walking capacity and early postoperative decline in walking endurance after GI cancer surgery. These findings support routine assessment of both LS and 6MWD to improve perioperative risk stratification and to inform targeted prehabilitation, including endurance-focused interventions for high-risk patients.