Abstract B111: Black-White differences in physical and cognitive aging among older breast cancer survivors in the Thinking and Living with Cancer Study

Introduction: While some cancer survivors experience minimal lasting effects of diagnosis and treatment, others report persistent decrements in physical and cognitive function. These changes may represent aging beyond that expected for the chronological age (i.e., “accelerated aging”). Racial minority groups often have an accelerated aging phenotype even before cancer diagnosis, partly due to chronic stress and other multi-level factors that affect aging and the ability to repair physiologic damage, leaving them more vulnerable to poor survivorship outcomes. However, we know little about physical and cognitive aging in this group and few studies have collected objective measures of physical and cognitive aging in minority cancer survivors. Methods: We examined changes in physical and cognitive function across 60 months of follow-up among Black and White survivors in the Thinking and Living with Cancer Study (TLC). TLC is an ongoing prospective multi-site cohort study recruiting non-metastatic breast cancer survivors aged ≥60 years. Participants completed questionnaires and objective assessments prior to systemic therapy with annual follow-up for up to 60 months. Physical function was measured using the timed up and go test (TUG); cognitive function was measured with Z scores on 11 neuropsychological tests for two domains: learning and memory (LM) and attention, processing, and executive function (APE). Mixed linear regression models predicting TUG, APE, or LM adjusted for age, study site, time, and cognitive reserve using the Wide Range Achievement Test (WRAT). Results: Black and White survivors in TLC were similar in age, education, comorbidities, and year of enrollment (p>0.14), but differed by study site (p<0.01) and WRAT score (p<0.01). On average, Black survivors had slower performance than White survivors on the TUG test (34 Black survivors, 366 White survivors; 12.6 seconds (SD=0.41) vs. 11.0 seconds (SD=0.13), respectively; p<0.001) at 12 months, but racial differences declined over time. Black survivors had poorer performance than White survivors for both LM and APE across 60 months of follow-up (94 Black survivors, 995 White survivors; p<0.001): mean Z scores were -0.23 (SD=0.08) among Black survivors and 0.31 (SD=0.03) among White survivors for LM and -0.29 (SD=0.06) among Black survivors and 0.1 (SD=0.02) among White survivors for APE. In multivariable models, race was a significant predictor of TUG score (β=0.94, p<0.01), LM score (β=-0.58, p<0.01), and APE score (β=-0.38, p<0.01). Conclusions: Older Black breast cancer survivors tended to have worse physical and cognitive function compared to older White breast cancer survivors and may experience accelerated decline. Additional studies are needed to address critical evidence gaps about the prevalence of poor physical and cognitive function, as well as aging trajectories, among Black breast cancer survivors.Citation Format: Traci N. Bethea, Wanting Zhai, Xingtao Zhou, Tim A. Ahles, Jaeil Ahn, Harvey J. Cohen, Asma A. Dilawari, Deena Graham, Heather Jim, Brenna C. McDonald, Zev M. Nakamura, Sunita K. Patel, Kelly E. Rentscher, James C. Root, Andrew J. Saykin, Brent J. Small, Kathleen Van Dyk, Jeanne S. Mandelblatt, Judith E. Carroll. Black-White differences in physical and cognitive aging among older breast cancer survivors in the Thinking and Living with Cancer Study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B111.

Duke Scholars

Author Harvey Jay Cohen Medicine, Geriatrics