Deficit Accumulation Frailty Trajectories of Older Breast Cancer Survivors and Non-Cancer Controls: The Thinking and Living With Cancer Study

Jeanne S Mandelblatt; Xingtao Zhou; Brent J Small; Jaeil Ahn; Wanting Zhai; Tim Ahles; Martine Extermann; Deena Graham; Paul B Jacobsen; Heather Jim; Brenna C McDonald; Sunita J Patel; James C Root; Andrew J Saykin; Harvey Jay Cohen; Judith E Carroll

doi:10.1093/jnci/djab003

Deficit Accumulation Frailty Trajectories of Older Breast Cancer Survivors and Non-Cancer Controls: The Thinking and Living With Cancer Study

J Natl Cancer Inst. 2021 Aug 2;113(8):1053-1064. doi: 10.1093/jnci/djab003.

Authors

Jeanne S Mandelblatt¹, Xingtao Zhou², Brent J Small³, Jaeil Ahn⁴, Wanting Zhai², Tim Ahles⁵, Martine Extermann⁶, Deena Graham⁷, Paul B Jacobsen⁸, Heather Jim⁹, Brenna C McDonald¹⁰, Sunita J Patel¹¹, James C Root^{12

13}, Andrew J Saykin¹⁴, Harvey Jay Cohen¹⁵, Judith E Carroll¹⁶

Affiliations

¹ Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
² Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
³ School of Aging Studies, University of South Florida, Health Outcome and Behavior Program and Biostatistics Resource Core, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL, USA.
⁴ Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
⁶ Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
⁷ John Theurer Cancer Center, Hackensack, NJ, USA.
⁸ Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
⁹ Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA.
¹⁰ Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA.
¹¹ Departments of Population Sciences and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
¹² Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
¹³ Departments of Psychiatry and Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA.
¹⁴ Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁵ Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹⁶ UCLA Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, and Cousins Center for Psychoneuroimmunology, Los Angeles, CA, USA.

Abstract

Background: We evaluated deficit accumulation and how deficits affected cognition and physical activity among breast cancer survivors and non-cancer controls.

Methods: Newly diagnosed nonmetastatic survivors (n = 353) and matched non-cancer controls (n = 355) ages 60-98 years without neurological impairments were assessed presystemic therapy (or at enrollment for controls) from August 2010 to December 2016 and followed for 36 months. Scores on a 42-item index were analyzed in growth-mixture models to determine deficit accumulation trajectories separately and combined for survivors and controls. Multilevel models tested associations between trajectory and cognition (FACT-Cog and neuropsychological tests) and physical activity (IPAQ-SF) for survivors and controls.

Results: Deficit accumulation scores were in the robust range, but survivors had higher scores (95% confidence intervals [CI]) than controls at 36 months (0.18, 95% CI = 0.16 to 0.19, vs 0.16, 95% CI = 0.14 to 0.17; P = .001), and averages included diverse deficit trajectories. Survivors who were robust but became frailer (8.8%) had similar baseline characteristics to those remaining robust (76.2%) but experienced a 9.6-point decline self-reported cognition (decline of 9.6 vs 3.2 points; P = .04) and a 769 MET minutes per week decline in physical activity (P < .001). Survivors who started and remained prefrail (15.0%) had self-reported and objective cognitive problems. At baseline, frail controls (9.5%) differed from robust controls (83.7%) on deficits and self-reported cognition (P < .001). Within combined trajectories, frail survivors had more sleep disturbances than frail controls (48.6% [SD = 17.4%] vs 25.0% [SD = 8.2%]; P = .05).

Conclusions: Most survivors and controls remained robust, and there were similar proportions on a frail trajectory. However, there were differences in deficit patterns between survivors and controls. Survivor deficit accumulation trajectory was associated with patient-reported outcomes. Additional research is needed to understand how breast cancer and its treatments affect deficit accumulation.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Breast Neoplasms* / complications
Breast Neoplasms* / epidemiology
Breast Neoplasms* / therapy
Cancer Survivors* / psychology
Female
Frail Elderly
Frailty*
Humans
Middle Aged
Neuropsychological Tests
Survivors

Abstract

Publication types

MeSH terms

Grants and funding