Pre-existing low back and joint pain is associated with locomotive syndrome deterioration in cancer patients following primary tumor resection: A prospective study

BACKGROUND: Locomotive syndrome is increasingly recognized as an important problem in cancer survivorship, but its early postoperative course after primary tumor resection remains unclear. This study aimed to clarify changes in locomotive syndrome stage after primary tumor resection and to identify clinical factors associated with postoperative deterioration. METHODS: We prospectively enrolled 142 patients with cancer who were hospitalized for primary tumor resection between May 2020 and December 2021. Locomotive syndrome was evaluated within seven days before surgery and at the 6-month postoperative assessment using the stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale. The primary outcome was locomotive syndrome deterioration, defined as an increase of at least one stage from baseline. RESULTS: Of the 142 enrolled patients, 104 completed both preoperative and postoperative assessments. Locomotive syndrome deterioration occurred in 30 patients (28.8%). Pre-existing pain in the low back or major joints was associated with a higher risk of deterioration than no such pain (38.6% versus 17.0%; odds ratio, 3.06; 95% confidence interval, 1.21-7.77; P = 0.019). Age, sex, body mass index, osteoporosis, baseline visceral metastasis, baseline bone metastasis, newly initiated chemotherapy, and newly initiated hormonal therapy were not significantly associated with deterioration. In a sensitivity analysis based only on physical performance tests, after excluding patients with baseline physical-performance-based Stage 3, the association between pre-existing pain in the low back or major joints and deterioration remained significant (odds ratio, 3.64; 95% confidence interval, 1.31-10.08; P = 0.012). CONCLUSIONS: Nearly 30% of patients experienced locomotive syndrome deterioration at the 6-month postoperative assessment. Pre-existing pain in the low back or major joints may help identify patients at risk for early postoperative decline in locomotor function.