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Longitudinal Relationship Between Frailty and Cognition in Patients 50 Years and Older with Breast Cancer.


ABSTRACT:

Objectives

To evaluate relationships between frailty and cognition longitudinally in adults 50 years and older with breast cancer receiving chemotherapy.

Design

Secondary analysis of a prospective longitudinal observational study.

Setting

University of Rochester NCI Community Oncology Research Program community oncology clinics.

Participants

Patients with breast cancer age 50 and older receiving adjuvant/neoadjuvant chemotherapy (n = 376) and age-matched controls without cancer (n = 234).

Measurements

Frailty was assessed using a modified frailty score from self-reported assessments (weakness, exhaustion, physical activity, and gait speed). Cognition was assessed by patient report (Functional Assessment of Cancer Therapy-Cognition [FACT-Cog]) and objective measures. Frailty and cognition were measured at three time points (prechemotherapy [A1], postchemotherapy [A2], and 6 months postchemotherapy [A3]; similar time interval for controls). Linear regression models evaluated associations between frailty and cognition adjusting for covariates.

Results

The average age was 59 years (standard deviation = 6.4 y). At baseline, patients with cancer had a higher mean frailty score (1.21 vs .73; P < .001) and lower mean FACT-Cog score (158.4 vs 167.3; P < .001) compared with controls. Objective cognitive measures were not statistically different. Longitudinal decline in FACT-Cog between A1 and A2 (P < .05) and between A1 and A3 (P < .01) was associated with increased frailty score in patients compared with controls. Longitudinal worsening in Controlled Oral Word Association (P < .05) and Trail-Making Test (P < .01) were associated with an increase in frailty between A1 and A2 in patients compared with controls; longitudinal decline in the Delayed Match to Sample test was associated with an increase in frailty between A1 and A3 (P < .05) in patients compared with controls. This finding remained significant for a subset analysis of those aged 65 and older.

Conclusion

In patients with breast cancer aged 50 and older, longitudinal decline in FACT-Cog and objective measures of attention and memory were associated with increased frailty during treatment and up to 6 months posttreatment. Overall, our study suggests cognition and frailty are both important factors to assess in breast cancer patients. J Am Geriatr Soc 67:928-936, 2019.

SUBMITTER: Magnuson A 

PROVIDER: S-EPMC6490967 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Publications

Longitudinal Relationship Between Frailty and Cognition in Patients 50 Years and Older with Breast Cancer.

Magnuson Allison A   Lei Lianlian L   Gilmore Nikesha N   Kleckner Amber S AS   Lin Feng V FV   Ferguson Robert R   Hurria Arti A   Wittink Marsha N MN   Esparaz Benjamin T BT   Giguere Jeffrey K JK   Misleh Jamal J   Bautista Javier J   Mohile Supriya G SG   Janelsins Michelle C MC  

Journal of the American Geriatrics Society 20190501 5


<h4>Objectives</h4>To evaluate relationships between frailty and cognition longitudinally in adults 50 years and older with breast cancer receiving chemotherapy.<h4>Design</h4>Secondary analysis of a prospective longitudinal observational study.<h4>Setting</h4>University of Rochester NCI Community Oncology Research Program community oncology clinics.<h4>Participants</h4>Patients with breast cancer age 50 and older receiving adjuvant/neoadjuvant chemotherapy (n = 376) and age-matched controls wit  ...[more]

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