Older Adult Cancer Survivors’ Functional Limitations and Determinants of Health: Evidence from the 2021 National Health Interview Survey

Background/Objectives: Functional limitations are common among older cancer survivors and tend to increase with age and survivorship duration. Physical activity (PA) associates with better functional outcomes, but little is known about how these associations vary as time passes post-diagnosis. This study examined how years since diagnosis, three types of physical activity, and their interactions associate with functional limitations in older cancer survivors. Methods: Data drawn from the 2021 National Health Interview Survey (NHIS), representing adults aged 55+ and with a prior cancer diagnosis (n = 9356; mean age = 72.17 ± 8.5 years), were studied. A four-item self-reported difficulty index (i.e., washing/dressing, walking one block, climbing stairs, and picking up/opening objects) was summed to measure functional limitations. PA was assessed using the items aligned with the United States PA Guidelines. Hierarchical regression was used to evaluate associations between functional limitations and years since diagnosis, vigorous physical activity, moderate physical activity, and strength training. Interaction effects of years since diagnosis and each activity type were also examined. Covariates were age, sex, BMI, and educational attainment. Results: Elapsed time since cancer diagnosis positively associated with functional limitations in interaction with physical behaviors, while moderate physical activity and strength training negatively associated with functional limitations. Interactions of years since diagnosis and both moderate physical activity and strength training revealed smaller increases in functional limitations. No interaction effects were observed for vigorous physical activity. Conclusions: Among older cancer survivors, the association between survivorship duration and functional limitations differs by engagement in moderate and resistance-based physical activity. These findings support the clinical importance of promoting sustainable, non-vigorous physical activity in long-term survivorship care.