Associations between frailty and cancer-specific mortality among older women with breast cancer

Yan, Connie; Coleman, Chandler; Nabulsi, Nadia A.; Chiu, Brian C.‐H.; Ko, Naomi; Hoskins, Kent; Calip, Gregory S.

doi:10.1007/s10549-021-06323-3

Cited by 14 publications

(6 citation statements)

References 53 publications

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“…7 Although our study provides mixed results as to frailty’s impact on health outcomes, most studies in the literature have reported that it is associated with negative health outcomes including postoperative complications, chemotherapy intolerance, disease progression, readmission, and mortality. 8-13 Although frailty may be associated with worse outcomes as has been reported, an important consideration is not simply that frailty influences outcomes after treatments but that treatment can make frailty worse as has been reported in other studies. 7,14-16…”

Section: Discussionmentioning

confidence: 89%

The Impact of Frailty on Adjuvant Therapies Not Offered to or Declined by Breast Cancer Surgery Patients

Solsky,

Cairns,

Martin

et al. 2023

The American Surgeon™

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Introduction The impact of frailty on adjuvant therapies not offered to or declined by elderly breast cancer surgery patients has been understudied. Methods This is a retrospective review of a prospectively managed single-center database including all breast cancer patients >65 years undergoing surgery in 2021. Frailty was determined using an electronic frailty index (eFI) derived from electronic health data. Patients were categorized as Fit (eFI ≤ .10), Pre-frail (.10 < eFI ≤.21), or Frail (eFI > .21). Chart review was performed to collect data on adjuvant therapies not offered or declined. Descriptive statistics and logistic regression were performed. Results Of 133 patients, 16.5% were frail, 46.6% were pre-frail, and 36.8% were fit. Demographics were similar among groups except age and comorbidities. Of those with adjuvant therapy indicated (n = 123), 15.4% were not offered at least one indicated therapy. Of those offered therapy, some therapy was declined in 22.7%. Frail patients more often were not offered or declined some therapy (frail: 63.2%, pre-frail 36.2%, fit: 28.2%, P = .03). Frailty was associated with having some therapy not offered or declined on univariate modeling (OR 4.4 95% CI 1.4-13.5, P = .01) but not on multivariate. Being frail was associated with higher odds of readmission at 6 months on multivariate analysis (OR 9.5, 95% CI: 1.7-54.2. P = .01). Conclusion Over half of frail patients are not offered or decline some adjuvant therapy. The impact of this requires further study. Given their higher odds of readmission, frail patients require close postoperative monitoring to prevent the interruption of adjuvant therapies.

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Section: Discussionmentioning

confidence: 89%

The Impact of Frailty on Adjuvant Therapies Not Offered to or Declined by Breast Cancer Surgery Patients

Solsky,

Cairns,

Martin

et al. 2023

The American Surgeon™

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“…Future studies should explore the effect of AROi upon these genetic changes in breast cancer patients, in order to stratify individuals with an increased risk of developing frailty or of suffering a worsening of frailty during AROi treatment. This is crucial, since the current oncology guidelines indicate at least 5 years of treatment with AROi in the adjuvant setting, and frailty syndrome in older women with breast cancer is associated to a higher risk of all-cause mortality, but not of breast cancer-specific mortality [ 33 ]. Regarding the individual component of frailty syndrome based on the physical phenotype of frailty [ 15 ], we observed significant worsening under AROi treatment in relation to two criteria, namely self-reported fatigue and gait speed.…”

Section: Discussionmentioning

confidence: 99%

Androstenedione and Follicle-Stimulating Hormone Concentration Predict the Progression of Frailty Syndrome at One Year Follow-Up in Patients with Localized Breast Cancer Treated with Aromatase Inhibitors

et al. 2022

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Background: The standard treatment in postmenopausal women with estrogen- and progesterone-positive localized breast cancer consists of aromatase inhibitors (AROi). The ability of AROi to promote or worsen frailty syndrome over time and the relationship with changes in gonadal hormones concentration in blood have not been investigated. Methods: A prospective study to evaluate the relationship between frailty syndrome and gonadal hormones concentrations in blood at baseline (prior to AROi treatment) and after 6 and 12 months under AROi treatment in post-menopausal women with breast cancer. Frailty syndrome was evaluated by the Fried’ criteria. We evaluated whether hormone concentration at baseline could predict frailty syndrome at follow-up. Results: Multinomial regression analysis showed that of the different hormones, those significantly (p < 0.05) associated to the worsening of frailty syndrome were high androstenedione levels and low follicle-stimulating hormone (FSH) levels in blood. Receiver operating characteristic curve analysis showed both androstenedione and FSH significantly (p < 0.05) discriminate patients who developed or presented worsening of frailty syndrome over time, with acceptable sensitivity (approximately 80% in both cases) but low specificity (40%). Conclusion: Hormonal concentrations before AROi treatment constitute possible biomarkers to predict the progression of frailty syndrome.

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“…Critically, frailty is associated with mortality in patients with cancer (18). Yan et al reported that higher degrees of frailty correlated with higher risk of mortality among a cohort of older patients with breast cancer (19). The body composition in patients with STS is thought to represent a marker of risk among patients with trunk and retroperitoneal sarcomas (20).…”

Section: Discussionmentioning

confidence: 99%

Doxorubicin Combined With Ifosfamide for Sarcoma Induces Muscle Atrophy and Sleep Disruption

et al. 2021

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Background/Aim: There are no reports evaluating sleep disturbance and skeletal muscle loss in response to the treatment of soft tissue sarcoma (STS) with chemotherapy. This study investigated the effects of combined doxorubicin (DXR) and ifosfamide (IFM) on sleep and skeletal muscle. Patients and Methods: This retrospective cohort study included 14 patients with high-grade STS. Participants underwent five 7-day hospitalizations during which they received chemotherapy for 5 consecutive days. Sleep analysis and muscle-volume evaluation were investigated using a wearable device during hospitalization and by bioelectrical impedance analysis at each chemotherapy course. Results: Chemotherapy significantly impeded sleep, increased waketime after sleep onset, and aggravated movement index during hospitalization. In long-term body composition assessment, chemotherapy induced muscle-mass loss and fatmass gain. Conclusion: Combination of DXR and IFM for STS induces skeletal muscle loss and sleep disruption.

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Associations between frailty and cancer-specific mortality among older women with breast cancer

Cited by 14 publications

References 53 publications

The Impact of Frailty on Adjuvant Therapies Not Offered to or Declined by Breast Cancer Surgery Patients

The Impact of Frailty on Adjuvant Therapies Not Offered to or Declined by Breast Cancer Surgery Patients

Androstenedione and Follicle-Stimulating Hormone Concentration Predict the Progression of Frailty Syndrome at One Year Follow-Up in Patients with Localized Breast Cancer Treated with Aromatase Inhibitors

Doxorubicin Combined With Ifosfamide for Sarcoma Induces Muscle Atrophy and Sleep Disruption

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