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Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer.

ABSTRACT: OBJECTIVES:To analyze self-reported changes in physical function in older women with breast cancer receiving adjuvant chemotherapy. DESIGN:Secondary analysis of the Cancer and Leukemia Group B (CALGB) 49907 prospective randomized clinical trial. SETTING:CALGB institutions in the United States. PARTICIPANTS:Women aged 65 and older with Stage I to III breast cancer enrolled in CALGB 49907 who had physical function data from before and after receipt of adjuvant chemotherapy (N=256; mean age 71.5, range 65-85). MEASUREMENTS:Participants were administered the physical function subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire before chemotherapy, at the end of chemotherapy, and 12 months after chemotherapy initiation. Functional decline was defined as a more than 10-point decrease from baseline at each time point. Resilience was defined as return to within 10 points of baseline. Multivariable regression was used to examine pretreatment characteristics associated with physical function changes. RESULTS:Of 42% of participants who had physical function decline from before to the end of chemotherapy, 47% recovered by 12 months (were resilient). Almost one-third experienced functional decline from before chemotherapy to 12 months later. Pretreatment fatigue was a risk factor for functional decline from before to the end of chemotherapy (P=.02). Risk factors for functional decline at 12 months included pretreatment dyspnea (P=.007) and being unmarried (P=.01). CONCLUSION:Functional decline was common in older women receiving adjuvant chemotherapy for breast cancer in a clinical trial. Although half recovered their physical function, one-third had a clinically meaningful decline at 12 months. Strategies are needed to prevent functional decline in older adults receiving chemotherapy. J Am Geriatr Soc 67:920-927, 2019.

SUBMITTER: Hurria A

PROVIDER: S-EPMC6391210 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer.

Hurria Arti A Soto-Perez-de-Celis Enrique E Allred Jacob B JB Cohen Harvey Jay HJ Arsenyan Anait A Ballman Karla K Le-Rademacher Jennifer J Jatoi Aminah A Filo Julie J Mandelblatt Jeanne J Lafky Jacqueline M JM Kimmick Gretchen G Klepin Heidi D HD Freedman Rachel A RA Burstein Harold H Gralow Julie J Wolff Antonio C AC Magrinat Gustav G Barginear Myra M Muss Hyman H

Journal of the American Geriatrics Society 20180826 5

<h4>Objectives</h4>To analyze self-reported changes in physical function in older women with breast cancer receiving adjuvant chemotherapy.<h4>Design</h4>Secondary analysis of the Cancer and Leukemia Group B (CALGB) 49907 prospective randomized clinical trial.<h4>Setting</h4>CALGB institutions in the United States.<h4>Participants</h4>Women aged 65 and older with Stage I to III breast cancer enrolled in CALGB 49907 who had physical function data from before and after receipt of adjuvant chemothe ...[more]

PMID: 30146695

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Project description:BACKGROUND:Cognitive decline is among the most feared treatment-related outcomes of older adults with cancer. The majority of older patients with breast cancer self-report cognitive problems during and after chemotherapy. Prior neuroimaging research has been performed mostly in younger patients with cancer. The purpose of this study was to evaluate longitudinal changes in brain volumes and cognition in older women with breast cancer receiving adjuvant chemotherapy. METHODS:Women aged ??60 years with stage I-III breast cancer receiving adjuvant chemotherapy and age-matched and sex-matched healthy controls were enrolled. All participants underwent neuropsychological testing with the US National Institutes of Health (NIH) Toolbox for Cognition and brain magnetic resonance imaging (MRI) prior to chemotherapy, and again around one month after the last infusion of chemotherapy. Brain volumes were measured using Neuroreader™ software. Longitudinal changes in brain volumes and neuropsychological scores were analyzed utilizing linear mixed models. RESULTS:A total of 16 patients with breast cancer (mean age 67.0, SD 5.39 years) and 14 age-matched and sex-matched healthy controls (mean age 67.8, SD 5.24 years) were included: 7 patients received docetaxel and cyclophosphamide (TC) and 9 received chemotherapy regimens other than TC (non-TC). There were no significant differences in segmented brain volumes between the healthy control group and the chemotherapy group pre-chemotherapy (p?>?0.05). Exploratory hypothesis generating analyses focusing on the effect of the chemotherapy regimen demonstrated that the TC group had greater volume reduction in the temporal lobe (change?=?-?0.26) compared to the non-TC group (change?=?0.04, p for interaction?=?0.02) and healthy controls (change?=?0.08, p for interaction?=?0.004). Similarly, the TC group had a decrease in oral reading recognition scores (change?=?-?6.94) compared to the non-TC group (change?=?-?1.21, p for interaction?=?0.07) and healthy controls (change?=?0.09, p for interaction?=?0.02). CONCLUSIONS:There were no significant differences in segmented brain volumes between the healthy control group and the chemotherapy group; however, exploratory analyses demonstrated a reduction in both temporal lobe volume and oral reading recognition scores among patients on the TC regimen. These results suggest that different chemotherapy regimens may have differential effects on brain volume and cognition. Future, larger studies focusing on older adults with cancer on different treatment regimens are needed to confirm these findings. TRIAL REGISTRATION:ClinicalTrials.gov, NCT01992432 . Registered on 25 November 2013. Retrospectively registered.

Project description:PurposeOlder cancer patients are at increased risk of cancer-related cognitive impairment. The purpose of this study was to assess the alterations in intrinsic brain activity associated with adjuvant chemotherapy in older women with breast cancer.MethodsChemotherapy treatment (CT) group included sixteen women aged ≥ 60 years (range 60-82 years) with stage I-III breast cancers, who underwent both resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological testing with NIH Toolbox for Cognition before adjuvant chemotherapy, at time point 1 (TP1), and again within 1 month after completing chemotherapy, at time point 2 (TP2). Fourteen age- and sex-matched healthy controls (HC) underwent the same assessments at matched intervals. Three voxel-wise rs-fMRI parameters: amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity, were computed at each time point. The changes in rs-fMRI parameters from TP1 to TP2 for each group, the group differences in changes (the CT group vs. the HC group), and the group difference in the baseline rs-fMRI parameters were assessed. In addition, correlative analysis between the rs-fMRI parameters and neuropsychological testing scores was also performed.ResultsIn the CT group, one brain region, which included parts of the bilateral subcallosal gyri and right anterior cingulate gyrus, displayed increased ALFF from TP1 to TP2 (cluster p-corrected = 0.024); another brain region in the left precuneus displayed decreased fALFF from TP1 to TP2 (cluster level p-corrected = 0.025). No significant changes in the rs-fMRI parameters from TP1 to TP2 were observed in the HC group. Although ALFF and fALFF alterations were observed only in the CT group, none of the between-group differences in rs-fMRI parameter changes reached statistical significance.ConclusionsOur study results of ALFF and fALFF alterations in the chemotherapy-treated women suggest that adjuvant chemotherapy may affect intrinsic brain activity in older women with breast cancer.

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Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer.

Publications

Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer.

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