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

Publication ,  Journal Article
Mandelblatt, JS; Zhou, X; Small, BJ; Ahn, J; Zhai, W; Ahles, T; Extermann, M; Graham, D; Jacobsen, PB; Jim, H; McDonald, BC; Patel, SJ ...
Published in: J Natl Cancer Inst
August 2, 2021

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.

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Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

August 2, 2021

Volume

113

Issue

8

Start / End Page

1053 / 1064

Location

United States

Related Subject Headings

  • Survivors
  • Oncology & Carcinogenesis
  • Neuropsychological Tests
  • Middle Aged
  • Humans
  • Frailty
  • Frail Elderly
  • Female
  • Cancer Survivors
  • Breast Neoplasms
 

Citation

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Mandelblatt, J. S., Zhou, X., Small, B. J., Ahn, J., Zhai, W., Ahles, T., … Carroll, J. E. (2021). Deficit Accumulation Frailty Trajectories of Older Breast Cancer Survivors and Non-Cancer Controls: The Thinking and Living With Cancer Study. J Natl Cancer Inst, 113(8), 1053–1064. https://doi.org/10.1093/jnci/djab003
Mandelblatt, Jeanne S., Xingtao Zhou, Brent J. Small, Jaeil Ahn, Wanting Zhai, Tim Ahles, Martine Extermann, et al. “Deficit Accumulation Frailty Trajectories of Older Breast Cancer Survivors and Non-Cancer Controls: The Thinking and Living With Cancer Study.J Natl Cancer Inst 113, no. 8 (August 2, 2021): 1053–64. https://doi.org/10.1093/jnci/djab003.
Mandelblatt JS, Zhou X, Small BJ, Ahn J, Zhai W, Ahles T, et al. 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):1053–64.
Mandelblatt, Jeanne S., et al. “Deficit Accumulation Frailty Trajectories of Older Breast Cancer Survivors and Non-Cancer Controls: The Thinking and Living With Cancer Study.J Natl Cancer Inst, vol. 113, no. 8, Aug. 2021, pp. 1053–64. Pubmed, doi:10.1093/jnci/djab003.
Mandelblatt JS, Zhou X, Small BJ, Ahn J, Zhai W, Ahles T, Extermann M, Graham D, Jacobsen PB, Jim H, McDonald BC, Patel SJ, Root JC, Saykin AJ, Cohen HJ, Carroll JE. 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.
Journal cover image

Published In

J Natl Cancer Inst

DOI

EISSN

1460-2105

Publication Date

August 2, 2021

Volume

113

Issue

8

Start / End Page

1053 / 1064

Location

United States

Related Subject Headings

  • Survivors
  • Oncology & Carcinogenesis
  • Neuropsychological Tests
  • Middle Aged
  • Humans
  • Frailty
  • Frail Elderly
  • Female
  • Cancer Survivors
  • Breast Neoplasms