Frailty and neurocognitive impairments in Chinese survivors of childhood cancer

Purpose: This study aimed to evaluate the prevalence and predictors of frailty and the association between frailty and neurocognitive impairments among Chinese survivors of childhood cancer.

Methods: A total of 185 survivors of childhood cancer were recruited from a long-term follow-up clinic in Hong Kong (response rate: 94.4%; 48.1% female; mean age 28.9 years, standard deviation = 6.7 years). Frailty was assessed using the Fried frailty criteria. Neurocognitive outcomes were evaluated using a performance-based test. Multivariable logistic regression was used to identify the predictors of frailty. Multivariable generalized linear models were used to explore the associations between frailty and cognitive outcomes.

Results: The proportions of survivors with frailty and pre-frailty were 22.7% and 27.0%, respectively. "Frail" survivors were more likely to be diagnosed with cancer at a younger age (odds ratio [OR] = 0.93, 95% confidence interval [CI]: 0.87-0.99, P = 0.041) and to have coexisting chronic health conditions (OR = 4.63, 95% CI: 1.68-12.80, P = 0.003) than "non-frail" and "pre-frail" survivors. Survivors with frailty exhibited worse attention detectability (unstandardized point estimate [Est] = 4.57, standard error [SE] = 1.69, P = 0.007), omissions (Est = 3.68, SE = 1.15, P = 0.001), and cognitive flexibility (Est = 8.08, SE = 3.08, P = 0.009) than "non-frail" and "pre-frail" survivors.

Conclusions: More than one fifth of the participating Chinese survivors of childhood cancer were identified as phenotypically frail. Frailty was associated with worse performance in attention and executive function.

Implications for cancer survivors: The findings highlight the needs for regular monitoring and early interventions that can modify the aging pathway in the cancer continuum, to mitigate frailty and improve psychosocial outcomes during long-term cancer survivorship.