Frailty and health-related quality of life in older women with breast cancer
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.
KeywordsFrailty 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.
- 1.Cancer Facts and Figures 2017. American Cancer Society, Atlanta. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf. Accessed 1 Mar 2017
- 2.Surveillance Epidemiology and End Results (SEER) Cancer Statistics Review (1975-2015) National Cancer Institute. http://seer.cancer.gov/faststats/index.php. Accessed 1 Mar 2018
- 3.Bluethmann SM, Mariotto AB, Rowland JH (2016) Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev 25(7):1029–1036. https://doi.org/10.1158/1055-9965.EPI-16-0133 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Stover AM, Mayer DK, Muss H, Wheeler SB, Lyons JC, Reeve BB (2014) Quality of life changes during the pre- to postdiagnosis period and treatment-related recovery time in older women with breast cancer. Cancer 120(12):1881–1889. https://doi.org/10.1002/cncr.28649 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A (2014) International Society of Geriatric Oncology Consensus on geriatric assessment in older patients with cancer. J Clin Oncol Off J Am Soc Clin Oncol 32:2595–2603. https://doi.org/10.1200/JCO.2013.54.8347 CrossRefGoogle Scholar
- 9.Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H, Rodin M, Panageas KS, Holland JC, Saltz L, Kris MG, Noy A, Gomez J, Jakubowski A, Hudis C, Kornblith AB (2005) Developing a cancer-specific geriatric assessment: a feasibility study. Cancer 104(9):1998–2005. https://doi.org/10.1002/cncr.21422 CrossRefPubMedGoogle Scholar
- 12.Guerard E, Deal A, Williams G, Jolly T, Wood W, Muss H (2015) Construction of a frailty index for older adults with cancer using a geriatric assessment. J Clin Oncol 33(suppl; abstr 9535):33 (supplement):abstr 9535Google Scholar
- 13.Guerard EJ, Deal AM, Chang Y, Williams GR, Nyrop KA, Pergolotti M, Muss HB, Sanoff HK, Lund JL (2017) Frailty index developed from a cancer-specific geriatric assessment and the association with mortality among older adults with cancer. J Natl Compr Cancer Netw 15(7):894–902. https://doi.org/10.6004/jnccn.2017.0122 CrossRefGoogle Scholar
- 17.Yost KJ, Eton DT, Garcia SF, Cella D (2011) Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients. J Clin Epidemiol 64(5):507–516. https://doi.org/10.1016/j.jclinepi.2010.11.018 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Cohen HJ, Smith D, Sun CL, Tew W, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Filo J, Katheria V, Hurria A, Cancer, Aging Research G (2016) Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy. Cancer 122(24):3865–3872. https://doi.org/10.1002/cncr.30269 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Magnuson A, Allore H, Cohen HJ, Mohile SG, Williams GR, Chapman A, Extermann M, Olin RL, Targia V, Mackenzie A, Holmes HM, Hurria A (2016) Geriatric assessment with management in cancer care: current evidence and potential mechanisms for future research. J Geriatr Oncol 7(4):242–248. https://doi.org/10.1016/j.jgo.2016.02.007 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Mandelblatt JS, Cai L, Luta G, Kimmick G, Clapp J, Isaacs C, Pitcher B, Barry W, Winer E, Sugarman S, Hudis C, Muss H, Cohen HJ, Hurria A (2017) Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance). Breast Cancer Res Treat 164(1):107–117. https://doi.org/10.1007/s10549-017-4222-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Chang YW, Chen WL, Lin FG, Fang WH, Yen MY, Hsieh CC, Kao TW (2012) Frailty and its impact on health-related quality of life: a cross-sectional study on elder community-dwelling preventive health service users. PLoS One 7(5):e38079. https://doi.org/10.1371/journal.pone.0038079 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Wildiers H, Mauer M, Pallis A, Hurria A, Mohile SG, Luciani A, Curigliano G, Extermann M, Lichtman SM, Ballman K, Cohen HJ, Muss H, Wedding U (2013) End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer--Alliance for clinical trials in oncology--international society of geriatric oncology position article. J Clin Oncol Off J Am Soc Clin Oncol 31(29):3711–3718. https://doi.org/10.1200/JCO.2013.49.6125 CrossRefGoogle Scholar