Frailty and health-related quality of life in older women with breast cancer

  • Grant R. Williams
  • Allison M. Deal
  • Hanna K. Sanoff
  • Kirsten A. Nyrop
  • Emily J. Guerard
  • Mackenzi Pergolotti
  • Shlomit S. Shachar
  • Bryce B. Reeve
  • Jeannette T. Bensen
  • Seul Ki Choi
  • Hyman B. Muss
Original Article



In older women, breast cancer and its treatment can have profound impact on their physical, mental, and social health, especially in frail patients. This study evaluated the association between frailty and long-term health-related quality of life (HRQOL) in older women undergoing breast cancer treatment.


Using the Carolina Senior Registry (CSR), participants with breast cancer were contacted to complete a follow-up HRQOL questionnaire (median 4 years). Baseline Geriatric Assessment (GA) variables were used to calculate the Carolina Frailty Index (CFI) and categorize participants as robust, pre-frail, or frail. Outcomes included HRQOL domains of physical function, social roles, fatigue, depression, anxiety, pain, and sleep disturbance assessed using PROMIS® instruments. Regression modeling compared outcomes between frailty groups using adjusted mean differences (AMD).


Of 190 eligible patients, 63 completed follow-up HRQOL survey. Mean age was 70 years (range 65–86) and 91% were white. Based on the CFI, 49 (78%) patients were robust, 11 (18%) pre-frail, and 3 (5%) frail. After controlling for age and cancer stage, patients identified as pre-frail/frail reported worse physical function (AMD − 9.2, p < 0.001) and social roles (AMD − 7.2, p = 0.002) and more fatigue (AMD 7.6, p = 0.008), depression (AMD 5.6, p = 0.004), and sleep disturbance (AMD 6.9, p = 0.008) compared to robust patients at follow-up.


Frailty in older women with breast cancer was associated with worse long-term HRQOL outcomes. Further research is needed to develop interventions for frail patients at-risk for reduced HRQOL.


Frailty Health-related quality of life Geriatric assessment Breast cancer Geriatric oncology 



Supported in part by the UNC Oncology Clinical Translational Research Training Program (NCI 5K12CA120780–07), the Breast Cancer Research Foundation (New York, NY), the University Cancer Research Fund at UNC, and the Clinical and Translational Science Award program of the National Center for Advancing Translational Sciences, National Institutes of Health (1UL1TR001111).

Compliance with ethical standards

This study complied with the laws and ethical standards of the United States and was approved by the Institutional Review Board of the University of North Carolina (IRB #15–2032).

Conflict of interest

Author Sanoff has received research funding from Merck and Bayer, and no other relevant conflicts of interest to declare.

Supplementary material

520_2018_4558_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Grant R. Williams
    • 1
  • Allison M. Deal
    • 2
  • Hanna K. Sanoff
    • 2
  • Kirsten A. Nyrop
    • 2
  • Emily J. Guerard
    • 3
  • Mackenzi Pergolotti
    • 4
  • Shlomit S. Shachar
    • 2
    • 5
  • Bryce B. Reeve
    • 6
  • Jeannette T. Bensen
    • 2
  • Seul Ki Choi
    • 2
  • Hyman B. Muss
    • 2
  1. 1.Divisions of Hematology/Oncology & Gerontology, Geriatrics, and Palliative Care, Institute of Cancer Outcomes and SurvivorshipUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Lineberger Comprehensive Cancer Center at the University of North CarolinaChapel HillUSA
  3. 3.University of Wisconsin at MadisonMadisonUSA
  4. 4.Colorado State UniversityFort CollinsUSA
  5. 5.Rambam Health Care CampusHaifaIsrael
  6. 6.Duke University School of MedicineDurhamUSA

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