Early ADL Improvement is Associated with the Survival Period in Patients with Cancer-Related Stroke

The purpose of this study was to determine the association between early ADL improvement and the survival period in patients with CRS.

The subjects of this study were 35 CRS patients who were hospitalized in our hospital and did physical therapy from January 2020 to December 2023. CRS was defined as an ischemic stroke occurring in active cancer patients who had D-dimer≥0.55 mg/L and multiple territory infarctions. Active cancer patients were referred to as those who were diagnosed and currently undergoing or refusing cancer treatment. Patients who were newly diagnosed with cancer during hospitalization for stroke were also included. The subjects were divided into two groups: 15 patients who improved modified Rankin Scale (mRS) and 20 patients who did not improve mRS within one week after CRS onset. Patient characteristics between the two groups were compared using the Mann-Whitney U test and chi-square test. Overall survival (OS) was calculated using the Kaplan-Meier method, and differences were assessed using the log-rank test. To determine whether the mortality was associated with mRS at CRS onset, changes in mRS in one week and ages, we performed multivariate Cox proportional hazard regression analyses. The differences were considered significant at P0.05.

Compared with patients who did not improve mRS, patients who improved mRS had more males, lower mRS and lower ECOG Performance States (PS) at CRS onset. There were no differences in ages and body mass index. The median survival of patients with an improved mRS was 113 days and those without improvement was 45 days. OS was different between the two groups (P0.05). In the multivariate Cox proportional hazard analysis, changes in mRS during the first week after CRS onset were independent risk factors for OS (hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.17 to 0.93; P0.05). mRS at CRS onset (HR, 1.14; 95% CI, 0.59 to 2.21; P=0.69) and ages (HR, 1.02; 95% CI, 0.97 to 1.06; P=0.45) were not significant in this analysis.

Patients who improved mRS within one week after CRS onset survived longer than those who did not improve mRS. Early ADL improvement may prolong the survival period in patients with CRS. Physical therapy for CRS patients should aim to improve ADL within one week.

This study highlights the importance of improving ADL as early as possible for CRS patients. Further research is needed including prospective studies with more cases and relevant factors.