Sex Differences in Disability–Function Discordance among Patients with Advanced Cancer: Toward a Gender-Informed Understanding of Functional Health Appraisal

Objectives: Disability and functioning are distinct dimensions of health status in patients with advanced cancer.The extent to which functional limitations are translated into perceived disability may differ by sex, yet sex differences in disability-function discordance remain poorly understood.This study investigated sex-specific patterns of disability-function discordance and their associations with psychological distress and mortality.Methods: This secondary analysis included 483 patients with advanced cancer enrolled in a prospective cohort study.Disability was assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and functioning was evaluated using the Korean Instrumental Activities of Daily Living (K-IADL).Participants were classified into four disability-function phenotypes according to median WHODAS and K-IADL scores: concordant low, subjective-high discordance, objective-high discordance, and concordant high.Multivariable logistic and multinomial regression analyses were performed to evaluate associations between sex and discordance phenotypes.Findings: The distribution of disability-function phenotypes differed significantly by sex (χ 2 =43.58, p<0.001).Women were more likely to exhibit subjective-high discordance (24.4% vs. 13.4%),whereas men were more likely to exhibit objective-high discordance (31.3% vs. 8.6%).After adjustment for age, cancer group, and Eastern Cooperative Oncology Group Performance Status, male sex was independently associated with objective-high discordance (odds ratio, 3.68; 95% confidence interval, 1.84-7.35;p<0.001) and inversely associated with subjective-high discordance (odds ratio, 0.43; 95% confidence interval, 0.22-0.85;p=0.016).These associations remained significant after exclusion of breast cancer patients.Objective-high discordance showed the highest observed mortality rate (15.3%).Conclusions: Distinct sex differences were observed in disability-function discordance among patients with advanced cancer.Women more frequently reported greater disability despite preserved functioning, whereas men more often demonstrated impaired functioning despite relatively low perceived disability.Integrating subjective and objective functional assessments may improve identification of vulnerable patients and support gender-informed supportive cancer care.