Skip to main content

Advertisement

SpringerLink
Log in

Frailty and health-related quality of life in older women with breast cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

In older women, breast cancer and its treatment can have profound impact on their physical, mental, and social health, especially in frail patients. This study evaluated the association between frailty and long-term health-related quality of life (HRQOL) in older women undergoing breast cancer treatment.

Methods

Using the Carolina Senior Registry (CSR), participants with breast cancer were contacted to complete a follow-up HRQOL questionnaire (median 4 years). Baseline Geriatric Assessment (GA) variables were used to calculate the Carolina Frailty Index (CFI) and categorize participants as robust, pre-frail, or frail. Outcomes included HRQOL domains of physical function, social roles, fatigue, depression, anxiety, pain, and sleep disturbance assessed using PROMIS® instruments. Regression modeling compared outcomes between frailty groups using adjusted mean differences (AMD).

Results

Of 190 eligible patients, 63 completed follow-up HRQOL survey. Mean age was 70 years (range 65–86) and 91% were white. Based on the CFI, 49 (78%) patients were robust, 11 (18%) pre-frail, and 3 (5%) frail. After controlling for age and cancer stage, patients identified as pre-frail/frail reported worse physical function (AMD − 9.2, p < 0.001) and social roles (AMD − 7.2, p = 0.002) and more fatigue (AMD 7.6, p = 0.008), depression (AMD 5.6, p = 0.004), and sleep disturbance (AMD 6.9, p = 0.008) compared to robust patients at follow-up.

Conclusions

Frailty in older women with breast cancer was associated with worse long-term HRQOL outcomes. Further research is needed to develop interventions for frail patients at-risk for reduced HRQOL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cancer Facts and Figures 2017. American Cancer Society, Atlanta. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf. Accessed 1 Mar 2017

  2. Surveillance Epidemiology and End Results (SEER) Cancer Statistics Review (1975-2015) National Cancer Institute. http://seer.cancer.gov/faststats/index.php. Accessed 1 Mar 2018

  3. Bluethmann SM, Mariotto AB, Rowland JH (2016) Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev 25(7):1029–1036. https://doi.org/10.1158/1055-9965.EPI-16-0133

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wedding U, Pientka L, Hoffken K (2007) Quality-of-life in elderly patients with cancer: a short review. Eur J Cancer 43(15):2203–2210. https://doi.org/10.1016/j.ejca.2007.06.001

    Article  PubMed  Google Scholar 

  5. Stover AM, Mayer DK, Muss H, Wheeler SB, Lyons JC, Reeve BB (2014) Quality of life changes during the pre- to postdiagnosis period and treatment-related recovery time in older women with breast cancer. Cancer 120(12):1881–1889. https://doi.org/10.1002/cncr.28649

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156

    Article  PubMed  CAS  Google Scholar 

  7. Balducci L, Extermann M (2000) Management of cancer in the older person: a practical approach. Oncologist 5(3):224–237

    Article  PubMed  CAS  Google Scholar 

  8. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A (2014) International Society of Geriatric Oncology Consensus on geriatric assessment in older patients with cancer. J Clin Oncol Off J Am Soc Clin Oncol 32:2595–2603. https://doi.org/10.1200/JCO.2013.54.8347

    Article  Google Scholar 

  9. Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H, Rodin M, Panageas KS, Holland JC, Saltz L, Kris MG, Noy A, Gomez J, Jakubowski A, Hudis C, Kornblith AB (2005) Developing a cancer-specific geriatric assessment: a feasibility study. Cancer 104(9):1998–2005. https://doi.org/10.1002/cncr.21422

    Article  PubMed  Google Scholar 

  10. Williams GR, Deal AM, Jolly TA, Alston SM, Gordon BB, Dixon SA, Olajide OA, Chris Taylor W, Messino MJ, Muss HB (2014) Feasibility of geriatric assessment in community oncology clinics. J Geriatr Oncol 5(3):245–251. https://doi.org/10.1016/j.jgo.2014.03.001

    Article  PubMed  Google Scholar 

  11. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K (2008) A standard procedure for creating a frailty index. BMC Geriatr 8:24. https://doi.org/10.1186/1471-2318-8-24

    Article  PubMed  PubMed Central  Google Scholar 

  12. Guerard E, Deal A, Williams G, Jolly T, Wood W, Muss H (2015) Construction of a frailty index for older adults with cancer using a geriatric assessment. J Clin Oncol 33(suppl; abstr 9535):33 (supplement):abstr 9535

    Google Scholar 

  13. Guerard EJ, Deal AM, Chang Y, Williams GR, Nyrop KA, Pergolotti M, Muss HB, Sanoff HK, Lund JL (2017) Frailty index developed from a cancer-specific geriatric assessment and the association with mortality among older adults with cancer. J Natl Compr Cancer Netw 15(7):894–902. https://doi.org/10.6004/jnccn.2017.0122

    Article  Google Scholar 

  14. Williams GR, Deal AM, Muss HB, Weinberg MS, Sanoff HK, Guerard EJ, Nyrop KA, Pergolotti M, Shachar SS (2017) Frailty and skeletal muscle in older adults with cancer. J Geriatr Oncol 9:68–73. https://doi.org/10.1016/j.jgo.2017.08.002

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nishijima TF, Deal AM, Williams GR, Guerard EJ, Nyrop KA, Muss HB (2017) Frailty and inflammatory markers in older adults with cancer. Aging (Albany NY) 9(3):650–664. https://doi.org/10.18632/aging.101162

    Article  CAS  Google Scholar 

  16. Cella DF (1995) Measuring quality of life in palliative care. Semin Oncol 22(2 Suppl 3):73–81

    PubMed  CAS  Google Scholar 

  17. Yost KJ, Eton DT, Garcia SF, Cella D (2011) Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients. J Clin Epidemiol 64(5):507–516. https://doi.org/10.1016/j.jclinepi.2010.11.018

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cohen HJ, Smith D, Sun CL, Tew W, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Filo J, Katheria V, Hurria A, Cancer, Aging Research G (2016) Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy. Cancer 122(24):3865–3872. https://doi.org/10.1002/cncr.30269

    Article  PubMed  PubMed Central  Google Scholar 

  19. Magnuson A, Allore H, Cohen HJ, Mohile SG, Williams GR, Chapman A, Extermann M, Olin RL, Targia V, Mackenzie A, Holmes HM, Hurria A (2016) Geriatric assessment with management in cancer care: current evidence and potential mechanisms for future research. J Geriatr Oncol 7(4):242–248. https://doi.org/10.1016/j.jgo.2016.02.007

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mandelblatt JS, Cai L, Luta G, Kimmick G, Clapp J, Isaacs C, Pitcher B, Barry W, Winer E, Sugarman S, Hudis C, Muss H, Cohen HJ, Hurria A (2017) Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance). Breast Cancer Res Treat 164(1):107–117. https://doi.org/10.1007/s10549-017-4222-8

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  21. Chang YW, Chen WL, Lin FG, Fang WH, Yen MY, Hsieh CC, Kao TW (2012) Frailty and its impact on health-related quality of life: a cross-sectional study on elder community-dwelling preventive health service users. PLoS One 7(5):e38079. https://doi.org/10.1371/journal.pone.0038079

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Moreno-Aguilar M, Garcia-Lara JM, Aguilar-Navarro S, Navarrete-Reyes AP, Amieva H, Avila-Funes JA (2013) The phenotype of frailty and health-related quality of life. J Frailty Aging 2(1):2–7. https://doi.org/10.14283/jfa.2013.1

    Article  PubMed  CAS  Google Scholar 

  23. Fried TR, Bradley EH, Towle VR, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346(14):1061–1066. https://doi.org/10.1056/NEJMsa012528

    Article  PubMed  Google Scholar 

  24. Wildiers H, Mauer M, Pallis A, Hurria A, Mohile SG, Luciani A, Curigliano G, Extermann M, Lichtman SM, Ballman K, Cohen HJ, Muss H, Wedding U (2013) End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer--Alliance for clinical trials in oncology--international society of geriatric oncology position article. J Clin Oncol Off J Am Soc Clin Oncol 31(29):3711–3718. https://doi.org/10.1200/JCO.2013.49.6125

    Article  Google Scholar 

Download references

Funding

Supported in part by the UNC Oncology Clinical Translational Research Training Program (NCI 5K12CA120780–07), the Breast Cancer Research Foundation (New York, NY), the University Cancer Research Fund at UNC, and the Clinical and Translational Science Award program of the National Center for Advancing Translational Sciences, National Institutes of Health (1UL1TR001111).

Author information

Authors and Affiliations

  1. Divisions of Hematology/Oncology & Gerontology, Geriatrics, and Palliative Care, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA

    Grant R. Williams

  2. Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, NC, USA

    Allison M. Deal, Hanna K. Sanoff, Kirsten A. Nyrop, Shlomit S. Shachar, Jeannette T. Bensen, Seul Ki Choi & Hyman B. Muss

  3. University of Wisconsin at Madison, Madison, WI, USA

    Emily J. Guerard

  4. Colorado State University, Fort Collins, CO, USA

    Mackenzi Pergolotti

  5. Rambam Health Care Campus, Haifa, Israel

    Shlomit S. Shachar

  6. Duke University School of Medicine, Durham, NC, USA

    Bryce B. Reeve

Authors
  1. Grant R. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allison M. Deal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hanna K. Sanoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kirsten A. Nyrop
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emily J. Guerard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mackenzi Pergolotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shlomit S. Shachar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bryce B. Reeve
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jeannette T. Bensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Seul Ki Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hyman B. Muss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Grant R. Williams.

Ethics declarations

This study complied with the laws and ethical standards of the United States and was approved by the Institutional Review Board of the University of North Carolina (IRB #15–2032).

Conflict of interest

Author Sanoff has received research funding from Merck and Bayer, and no other relevant conflicts of interest to declare.

Electronic supplementary material

ESM 1

(DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Williams, G.R., Deal, A.M., Sanoff, H.K. et al. Frailty and health-related quality of life in older women with breast cancer. Support Care Cancer 27, 2693–2698 (2019). https://doi.org/10.1007/s00520-018-4558-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4558-6

Keywords

Search

Navigation