Journal of Cancer Survivorship

, Volume 10, Issue 4, pp 736–742 | Cite as

Cancer and frailty in older adults: a nested case-control study of the Mexican Health and Aging Study

  • Mario Ulises Pérez-Zepeda
  • Eduardo Cárdenas-Cárdenas
  • Matteo Cesari
  • Ana Patricia Navarrete-Reyes
  • Luis Miguel Gutiérrez-Robledo
Article

Abstract

Purpose

Understanding how the convergence between chronic and complex diseases—such as cancer—and emerging conditions of older adults—such as frailty—takes place would help in halting the path that leads to disability in this age group. The objective of this manuscript is to describe the association between a past medical history of cancer and frailty in Mexican older adults.

Methods

This is a nested in cohort case-control study of the Mexican Health and Aging Study. Frailty was categorized by developing a 55-item frailty index that was also used to define cases in two ways: incident frailty (incident >0.25 frailty index score) and worsening frailty (negative residuals from a regression between 2001 and 2012 frailty index scores). Exposition was defined as self-report of cancer between 2001 and 2012. Older adults with a cancer history were further divided into recently diagnosed (<10 years) and remotely diagnosed (>10 years from the initial diagnosis). Odds ratios were estimated by fitting a logistic regression adjusted for confounding variables.

Results

Out of a total of 8022 older adults with a mean age of 70.6 years, the prevalence of a past medical history of cancer was 3.6 % (n = 288). Among these participants, 45.1 % had been diagnosed with cancer more than 10 years previously. A higher risk of incident frailty compared to controls [odds ratio (OR) 1.53 (95 % confidence interval (CI) 1.04–2.26, p = 0.03); adjusted model OR 1.74 (95 % CI 1.15–2.61, p = 0.008)] was found in the group with a recent cancer diagnosis. Also, an inverse association between a remote cancer diagnosis and worsening frailty was found [OR = 0.56 (95 % CI 0.39–0.8), p = 0.002; adjusted model OR 0.61 (95 % CI 0.38–0.99, p = 0.046)].

Conclusions

Cancer is associated with a higher frailty index, with a potential relevant role of the time that has elapsed since the cancer diagnosis.

Implications for cancer survivors

Cancer survivors may be more likely to develop frailty or worsening of the health status at an older age. This relationship seems especially evident among individuals with a recent oncological diagnosis. Health professionals in charge of older adult care should be aware of this association in order to improve outcomes of older adults who survived cancer.

Keywords

Oncogeriatrics Frailty Chronic disease Disability 

Supplementary material

11764_2016_519_MOESM1_ESM.docx (93 kb)
Supplementary Table 1(DOCX 93 kb)

References

  1. 1.
    Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C et al. Cancer incidence and mortality worldwide: IARC CancerBase No. 11. In: GLOBOCAN 2012. http://globocan.iarc.fr. 2012. Accessed 11/04/2015 2015.
  2. 2.
    Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Yancik R, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer. 2002;94(10):2766–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist. 2007;12(1):20–37. doi:10.1634/theoncologist.12-1-20.CrossRefPubMedGoogle Scholar
  4. 4.
    Morley JE, Haren MT, Rolland Y, Kim MJ. Frailty. Med Clin N Am. 2006;90(5):837–47. doi:10.1016/j.mcna.2006.05.019.CrossRefPubMedGoogle Scholar
  5. 5.
    Rockwood K, Hubbard R. Frailty and the geriatrician. Age Ageing. 2004;33(5):429–30. doi:10.1093/ageing/afh15333/5/429.CrossRefPubMedGoogle Scholar
  6. 6.
    Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Rouge Bugat ME, Balardy L, Chicoulaa B, Cesari M, Gerard S, Nourashemi F. “Frailty” in geriatry and oncology: one term for two widely differing concepts. J Am Med Dir Assoc. 2014;15(7):528–30. doi:10.1016/j.jamda.2014.04.006.CrossRefPubMedGoogle Scholar
  8. 8.
    Balducci L, Beghe C. The application of the principles of geriatrics to the management of the older person with cancer. Crit Rev Oncol Hematol. 2000;35(3):147–54.CrossRefPubMedGoogle Scholar
  9. 9.
    Cesari M, Colloca G, Cerullo F, Ferrini A, Testa AC, Foti E, et al. Onco-geriatric approach for the management of older patients with cancer. J Am Med Dir Assoc. 2011;12(2):153–9. doi:10.1016/j.jamda.2010.06.008.CrossRefPubMedGoogle Scholar
  10. 10.
    Mohile SG, Xian Y, Dale W, Fisher SG, Rodin M, Morrow GR, et al. Association of a cancer diagnosis with vulnerability and frailty in older medicare beneficiaries. J Natl Cancer Inst. 2009;101(17):1206–15. doi:10.1093/jnci/djp239.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Rockwood K, Stadnyk K, MacKnight C, McDowell I, Hebert R, Hogan DB. A brief clinical instrument to classify frailty in elderly people. Lancet. 1999;353(9148):205–6. doi:10.1016/S0140-6736(98)04402-X.CrossRefPubMedGoogle Scholar
  12. 12.
    Cesari M, Gambassi G, van Abellan Kan G, Vellas B. The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing. 2014;43(1):10–2.CrossRefPubMedGoogle Scholar
  13. 13.
    Wong R, Espinoza M, Palloni A. Mexican older adults with a wide socioeconomic perspective: health and aging. Salud Publica Mex. 2007;49 Suppl 4:S436–47.PubMedGoogle Scholar
  14. 14.
    Wong R, Michaels-Obregon A, Palloni A. Cohort profile: the Mexican Health and Aging Study (MHAS). Int J Epidemiol. 2015. doi:10.1093/ije/dyu263.PubMedCentralGoogle Scholar
  15. 15.
    Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8:24. doi:10.1186/1471-2318-8-24.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62(7):738–43.CrossRefPubMedGoogle Scholar
  17. 17.
    Lynch SM, George LK. Interlocking trajectories of loss-related events and depressive symptoms among elders. J Gerontol Ser B Psychol Sci Soc Sci. 2002;57:S117–25.CrossRefGoogle Scholar
  18. 18.
    Mejia-Arango S, Gutierrez LM. Prevalence and incidence rates of dementia and cognitive impairment no dementia in the Mexican population: data from the Mexican Health and Aging Study. J Aging Health. 2011;23(7):1050–74. doi:10.1177/0898264311421199.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Roorda C, Berendsen AJ, Groenhof F, van der Meer K, de Bock GH. Increased primary healthcare utilisation among women with a history of breast cancer. Support Care Cancer. 2013;21(4):941–9. doi:10.1007/s00520-012-1609-2.CrossRefPubMedGoogle Scholar
  20. 20.
    Smith MR, Saad F, Egerdie B, Sieber PR, Tammela TL, Ke C, et al. Sarcopenia during androgen-deprivation therapy for prostate cancer. J Clin Oncol. 2012;30(26):3271–6. doi:10.1200/JCO.2011.38.8850.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Maccormick RE. Possible acceleration of aging by adjuvant chemotherapy: a cause of early onset frailty? Med Hypotheses. 2006;67(2):212–5. doi:10.1016/j.mehy.2006.01.045.CrossRefPubMedGoogle Scholar
  22. 22.
    Campisi J. Aging, cellular senescence, and cancer. Annu Rev Physiol. 2013;75:685–705. doi:10.1146/annurev-physiol-030212-183653.CrossRefPubMedGoogle Scholar
  23. 23.
    Kanapuru B, Ershler WB. Inflammation, coagulation, and the pathway to frailty. Am J Med. 2009;122(7):605–13. doi:10.1016/j.amjmed.2009.01.030.CrossRefPubMedGoogle Scholar
  24. 24.
    Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med. 2002;162(20):2333–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Oeffinger KC, Mertens AC, Hudson MM, Gurney JG, Casillas J, Chen H, et al. Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Ann Fam Med. 2004;2(1):61–70.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Potosky AL, Han KJ, Rowland J, Klabunde CN, Smith T, Aziz N, et al. Differences between primary care physicians’ and oncologists’ knowledge, attitudes and practices regarding the care of cancer survivors. J Gen Intern Med. 2011;26(12):1403–310. doi:10.1007/s11606-011-1808-4.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Del Giudice ME, Grunfeld E, Harvey BJ, Piliotis E, Verma S. Primary care physicians’ views of routine follow-up care of cancer survivors. J Clin Oncol. 2009;27(29):3338–45. doi:10.1200/JCO.2008.20.4883.CrossRefPubMedGoogle Scholar
  28. 28.
    Ligibel JA, Denlinger CS. New NCCN guidelines for survivorship care. J Natl Compr Cancer Netw. 2013;11(5 Suppl):640–4.Google Scholar
  29. 29.
    Angelopoulos N, Barbounis V, Livadas S, Kaltsas D, Tolis G. Effects of estrogen deprivation due to breast cancer treatment. Endocr Relat Cancer. 2004;11(3):523–35.CrossRefPubMedGoogle Scholar
  30. 30.
    Turner JP, Shakib S, Singhal N, Hogan-Doran J, Prowse R, Johns S, et al. Prevalence and factors associated with polypharmacy in older people with cancer. Support Care Cancer. 2014;22(7):1727–34. doi:10.1007/s00520-014-2171-x.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mario Ulises Pérez-Zepeda
    • 1
  • Eduardo Cárdenas-Cárdenas
    • 2
  • Matteo Cesari
    • 3
    • 4
  • Ana Patricia Navarrete-Reyes
    • 5
  • Luis Miguel Gutiérrez-Robledo
    • 6
  1. 1.Geriatric Epidemiology Research DepartmentInstituto Nacional de GeriatríaMéxico DFMexico
  2. 2.Oncology Service, Hospital 20 de NoviembreInstituto de Salud y Seguridad Social de los Trabajadores del EstadoMexico CityMexico
  3. 3.GérontopôleCentre Hospitalier Universitaire de ToulouseToulouseFrance
  4. 4.Université de Toulouse III Paul SabatierToulouseFrance
  5. 5.Geriatric DepartmentInstituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”Mexico CityMexico
  6. 6.Principal Office at the Instituto Nacional de GeriatríaMexico CityMexico

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