Highlights
- •Activities of Daily Living (ADLs) are essential to live independently within society.
- •One-third of adults with cancer have difficulty performing basic ADLs.
- •Half of adults with cancer require assistance to perform instrumental ADLs.
- •The most commonly affected ADLs include walking and transfers, housework, shopping and transportation.
Abstract
Introduction
Methods
Results
Conclusions
Keywords
Introduction
Method
Design
Inclusion and exclusion criteria
Search strategy
Data collection and analysis
Selection of studies
Assessment of methodological quality in included studies
Data extraction and analysis
Results
Study retrieval

Characteristics of included studies and sample participants
First author/year/ country | Study design | Setting | ADL outcome measures | Sample characteristics | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Sample size (n) | Age Mean ± SD (years) | Male (%) | Ethnicity (%) | Cancer type (% of sample) | Cancer stage (% of sample) | PS (%) | Treatment (%) | ||||
Bentley 2013 UK [24] | Cross-sectional | Outpatient | Occupational Performance Problem List | 260 | 71 ± 10 | 62 | White (90) | NSCLC (81) | NSCLC IV (55) | ECOG 0 (28) | Palliative (79) |
Chen 2007 USA [25] | Retrospective cohort | Inpatient | MDS – ADL | 63 | 91 ± 6 | 33 | ns | ns | ns | ns | ns |
Cheville 2008 USA [26] | Cross-sectional | Outpatient | OARS – ADL and IADL | 163 | 56 ± 1 | 0 | White (71) | Breast (100) | IV (26) | ns | ns |
Cole 2000 USA [27] | Retrospective case series | Inpatient | FIM Motor Measure | 200 | 71 ± 12 | 46 | ns | Blood-related (17) Lung (17) | III (72) | ns | Curative (76) |
Corsonello 2010 Italy [28] | Observational | Inpatient | Katz ADL | 1398 | 65–79 years (45%) | 63 | ns | GI (30) | NA | ns | ns |
Deckx 2015 Belgium; Netherlands [29] | Prospective observational cohort | Inpatient | Katz ADL Lawton IADL | 134 | 77.1 | 21 | ns | Breast (69) | II (54) | ns | Surgery (93) |
Deeg 2005 Netherlands [30] | Prospective longitudinal | Outpatient | OECD – 3 activities | 254 | ns | ns | ns | ns | ns | ns | ns |
de Miguel Sánchez 2006 Spain [31] | Prospective longitudinal | Outpatient | Katz ADL | 98 | 72 ± 12 | 61 | ns | GI (28) | Metastases (87) | PPS score 50 (33) | ns |
Derks 2004 Netherlands [32] | Prospective longitudinal | Outpatient | ADL and IADL questionnaires | 121 | 45–60 years (61%) | 64 | ns | Oral cavity (46) | ns | KPS 90–100 (87) | Surgical (76) |
Echteld 2004 Netherlands [33] | Prospective longitudinal | Inpatient | RAI-MDS-PC | 355 | 73 ± 13 | 45 | ns | Lung (20) | ns | ns | ns |
Extermann 1998 USA [34] | Prospective cohort | Outpatient | Katz ADL Lawton IADL | 203 | 76 ± 8 | 39 | ns | Breast (34) | Metastatic (47) | ECOG 1 (53) | ns |
Finalyson 2012 USA [35] | Retrospective cohort | Inpatient | MDS – ADL | 6822 | 83 ± 8 | 32 | White (86) | ns | ns | ns | ns |
Flood 2006 USA [36] | Retrospective descriptive | Inpatient | Katz ADL Lawton IADL | 96 (Katz ADL) 91 (Lawton IADL) | 74 ± 6 | 48 | White (77) | Lung (30) | ns | ns | ns |
Gill 2010 USA [12] | Longitudinal | Outpatient | 4-item ADL questionnaire | 74 | 82 ± 5 | 39 | White (91) | ns | ns | ns | ns |
Girones 2012 Spain [37] | Prospective | Outpatient | 5-item Katz ADL Lawton IADL | 83 | 77 ± 5 | 98 | ns | NSCLC (76) | III (41) | ECOG 1 (40) | ns |
Given 1994 USA [38] | Prospective longitudinal | Outpatient | Katz ADL Lawton IADL | 111 | 63 ± 7 | 50 | ns | GI (29) | ns | ns | CT + Other (78) |
Greimel 2000 Austria [39] | Prospective | Outpatient | ALLTAG | 98 | 56 ± 13 | 0 | ns | Cervical (47) | ns | ns | Surgery (51) |
Guadagnoli 1991 USA [40] | Cross-sectional | Outpatient | Telephone interviews on ADL/IADL | 413 | 65–75 years (29%) | 29 | White (98) | Breast (47) | ns | ns | Palliative (63) |
Hamaker 2011 Netherlands [41] | Prospective observational cohort | Inpatient | Katz ADL Modified Katz IADL | 292 | 78 ± 9 | 51 | ns | ns | Metastases (43) | ns | ns |
Huijberts 2016 Netherlands [42] | Prospective cohort | Inpatient | Modified Katz ADL | 151 | 76 ± 7 | 46 | Dutch (91) | ns | ns | ns | ns |
Hunter 2012 USA [43] | Retrospective | Inpatient | FIM Motor Measure | 215 | 61 ± 16 | 49 | ns | ns | ns | ns | ns |
Hurria 2006 USA [44] | Prospective longitudinal | Outpatient | Katz ADL Lawton IADL | 50 | 71 ± 6 | 51 | White (80) | Breast (100) | IIA (49) | ns | Lumpectomy (63) |
Kanesvaran 2014 China [45] | Prospective | Inpatient | 5-item ADL questionnaire OARS – IADL | 803 | 76 ± 8 | 60 | Han (95) | Lung (33) | IV (56) | ns | CT (44) |
Kim 2011 Korea [46] | Prospective | Outpatient | MBI Lawton IADL | 65 | 72 ± 4 | 75 | ns | Colorectal (34) | IV (49) | ECOG 0–1 (89) | Palliative CT (74) |
Korouklian 2010 USA [47] | Retrospective database review | Outpatient | ADLs recorded in the OASIS | 1009 | 75–79 years (26%) | 43 | Non-African American (92) | Colorectal (100) | Localised (74) | ns | ns |
Lindahl-Jacobsen 2015 Denmark [48] | Cross-sectional | Inpatient | ADL – Q | 118 | 70 ± 10 | 35 | ns | Lung (29) | ns | KPS score 50–70 (86) | ns |
Lindsey 1994 USA [49] | Prospective longitudinal | Outpatient | FAI ADL and IADL | 45 | 72 ± 7 | 36 | White (91) | Lung (57) | ns | ns | ns |
Luciani 2008 USA [50] | Retrospective cross sectional | Outpatient | Katz ADL Lawton IADL | 214 | 79 ± 5 | 37 | ns | ns | ns | ECOG 0 (62) | ns |
Lunney 2003 USA [11] | Prospective longitudinal | Outpatient | Interview on 7 ADLs | 897 | 78 ± 7 | 63 | White (80) | ns | ns | ns | ns |
Marcinak 1996 USA [51] | Retrospective case series | Inpatient | FIM Motor Measure | 159 | 57 ± 17 | 49 | ns | Primary intracranial (45) | ns | ns | Surgery (86) |
McCarthy 2000 USA [52] | Prospective cohort | Outpatient | 7-item Modified Katz Index ADL | 1063 | 64 ± 8 | 61 | White (84) | NSCLC (70) | ns | ns | CT (61) |
McEwen 2012 Canada [53] | Retrospective record review | Inpatient | FIM Motor Measure | 153 | 73 ± 13 | 41 | ns | Colorectal (29) | ns | ns | ns |
Movsas 2003 USA [54] | Prospective cohort | Inpatient | FIM Motor Measure | 55 | 61 ± 17 | ns | ns | Hematologic (40) | Metastatic (69) | ns | ns |
O’Hare 1993 USA [55] | Longitudinal | Outpatient | ESDS | 63 | ≥65 years (48%) | 38 | ns | ns | ns | ns | ns |
Ögce 2008 Turkey [56] | Longitudinal descriptive | Outpatient | IFS-CA | 101 | >50 years (50%) | 0 | ns | Breast (100) | Localised (52) | ns | Mastectomy (98) |
Repetto 2002 Italy [57] | Prospective cross-sectional | Inpatient | Katz ADL Lawton IADL | 363 | 76 ± 8 | 46 | ns | Breast (31) | Localised (40) | ECOG < 2 (74) | ns |
Retornaz 2007 France [58] | Retrospective chart review | Outpatient | Katz ADL 4-item IADL scale | 144 | 79 ± 7 | 46 | ns | Breast (18) | Metastases (75) | ns | None (58) |
Retornaz 2008 France [59] | Retrospective chart review | Inpatient | Katz ADL 4-item IADL scale | 186 | 80 ± 7 | 48 | ns | Breast (15) | Metastases (71) | ns | None (46) |
Serraino 2001 Italy [60] | Cross-sectional | Inpatient | Katz ADL Lawton IADL | 303 | 76 ± 8 | 60 | ns | Haematological neoplasia (60) | ns | ECOG 0–1 (62) | ns |
Silver 2010 Brazil [61] | Prospective longitudinal | Outpatient | Katz ADL 6-item Lawton IADL | 60 | 61 ± 12 | 88 | White (95) | Mouth (40) | IV (35) | ns | Surgery (82) RT (82) |
Stafford 1997 USA [62] | Cross-sectional | Outpatient | 6-item ADL questionnaire 6-item IADL questionnaire | 1647 | 75 | 33 | ns | Breast (24) | ns | ns | ns |
Tay 2009 Singapore [63] | Prospective cohort | Inpatient | FIM | 58 | 57 ± 16 | 62 | ns | Solid tumour (86) | ns | ns | RT (25.9) |
Ulander 1997 Sweden [64] | Exploratory | Outpatient | Katz Index and Hulter-Asberg's IADL index | 86 | 70 ± 13 | 54 | ns | Colorectal (100) | Metastases (44) | ns | ns |
Instruments, items and reporting of ADL disability
Methodological quality assessment
ADL disability in adults with cancer
Disability relating to basic ADLs

Disability relating to instrumental ADLs
Number of ADLs affected and ADL disability scores
First author | Clinical setting | ADL outcome measures | Basic ADL (mean ± SD) | Instrumental ADL (mean ± SD) |
---|---|---|---|---|
Retornaz 2008 [59] | Inpatient | 6-item Katz ADL 4-item IADL scale | 5.0 ± 2.3 | 3.0 ± 1.6 |
Cheville 2008 [26] | Outpatient | OARS – 7-item ADL and 7-item IADL | 1.8 ± 0.8 | 2.4 ± 2.1 |
Girones 2012 [37] | Outpatient | 5-item Katz ADL 6-item Lawton IADL | 4.0 ± 1.0 | 3.0 ± 2.0 |
Lunney 2003 [11] | Outpatient | Interview on 7 ADLs | 0.7 | ns |
McCarthy 2000 [52] | Outpatient | 7-item Modified Katz ADL | 1.3 | ns |
Silver 2010 [61] | Outpatient | 6-item Katz ADL 6-item Lawton IADL | 0.6 ± 1.7 | 3.1 ± 3.3 |
Stafford 1997 | Outpatient | 6-item ADL questionnaire 6-item IADL questionnaire | 1.0 | 0.9 |
First author | Clinical setting | ADL outcome measures | Range | Basic ADL (mean ± SD) | Instrumental ADL (mean ± SD) |
---|---|---|---|---|---|
Chen 2007 [25] | Inpatient | MDS – ADL | 0–28 | 12.6 ± 9.6 | ns |
Cole 2000 [27] | Inpatient | FIM Motor Measure | 0–100 | 43.7 ± 6.3 | ns |
Finalyson 2012 [35] | Inpatient | MDS – ADL | 0–28 | 12.7 ± 8.2 | ns |
Flood 2006 [36] | Inpatient | Katz Index Lawton IADL | 6–18 8–21 | 13.1 ± 2.7 | 19.7 ± 5.0 |
Hunter 2012 [43] | Inpatient | FIM Motor Measure | 13–91 | 61 ± 17 | ns |
Marcinak 1996 [51] | Inpatient | FIM Motor Measure | 0–100 | 42.6 | ns |
McEwen 2012 [53] | Inpatient | FIM Motor Measure | 13–91 | 58.0 ± 10.6 | ns |
Movsas 2003 [54] | Inpatient | FIM Motor Measure | 13–91 | 72.0 ± 14.0 | ns |
Tay 2009 [63] | Inpatient | FIM | 18–126 | 70.9 ± 18.0 | ns |
Lindsey 1994 [49] | Outpatient | FAI ADL and IADL | 13–26 15–29 | 25.5 ± 1.2 | 28.2 ± 1.5 |
Cheville 2009 [26] | Outpatient | FIM Mobility scale | 5–35 | 30.2 ± 5.8 | ns |
Derks 2004 [32] | Outpatient | ADL and IADL questionnaires | ns | 19.9, | 17.5, |
Hurria 2006 [44] | Outpatient | 6-item Katz ADL Lawton IADL | 6–18 8–21 | 18.0 | 21.0 |
Disability in specific ADLs


Discussion
Measurement of ADL disability
Reporting of ADL related disability
Characteristics of ADL related disability
Prevalence of ADL disability
ADL disability higher in inpatients than outpatient
A hierarchical relationship in ADL
Strengths and limitations
Future work
Conclusions
Declaration of interests
Competing interests
Acknowledgements
Contributors
Appendix A. Supplementary material
- Supplementary data 1
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