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Associations between frailty and cancer-specific mortality among older women with breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Frailty is assessed when making treatment decisions among older women with breast cancer (BC), which in turn impacts survival. We evaluated associations between pre-diagnosis frailty and risks of BC-specific and all-cause mortality in older women.

Methods

We conducted a retrospective cohort study of Medicare beneficiaries ages ≥ 65 years with stage I–III BC using the Surveillance, Epidemiology and End Results-Medicare Health Outcome Survey Data Resource. Frailty was measured using the deficit-accumulation frailty index, categorized as robust, pre-frail, or frail, at baseline and during follow-up. Fine and Gray competing risk and Cox proportional hazards models were used to estimate subdistribution hazard ratios (SHR) and hazard ratios (HR) with 95% confidence intervals (CI) for BC-specific and all-cause mortality, respectively.

Results

Among 2411 women with a median age of 75 years at BC diagnosis, 49.5% were categorized as robust, 29.4% were pre-frail and 21.1% were frail. Fewer frail women compared to robust women received breast-conserving surgery (52.8% vs. 61.5%, frail vs. robust, respectively) and radiation (43.5% vs. 51.8%). In multivariable analyses, degree of frailty was not associated with BC-specific mortality (frail vs robust SHR 1.47, 95% CI 0.97–2.24). However, frail women with BC had higher risks of all-cause mortality compared to robust women with BC (HR 2.32, 95% CI 1.84–2.92).

Conclusion

Among a cohort of older women with BC, higher degrees of frailty were associated with higher risk of all-cause mortality, but not BC-specific mortality. Future study should examine if preventing progression of frailty may improve all-cause mortality.

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Data availability

The authors have full control of all primary data. The data that support the findings of this study are available from the SEER-MHOS data resource. Restrictions apply to the availability of these data, which were used under license of this study.

Abbreviations

BC:

Breast cancer

BMI:

Body mass index

CI:

Confidence interval

DAFI:

Deficit-accumulation frailty index

HR:

Hazard ratios

HRQOL:

Health-related quality of life

IQR:

Interquartile ranges

MHOS:

Medicare Health Outcomes Survey

PH:

Proportional hazards

SEER:

Surveillance, Epidemiology and End Results

SHR:

Subdistribution hazard ratios

US:

United States

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Acknowledgements

This study used date from the Surveillance, Epidemiology, and End Results (SEER)—Medicare Health Outcomes Survey (MHOS) linked data resource. The authors acknowledge the effects of the National Cancer Institute; the Centers for Medicare and Medicaid Services; MHOS; Information Management Services, Inc; and the SEER Program tumor registries in the creation of the SEER-MHOS database. The National Cancer Institute provided suggested edits and approval of the manuscript before final journal submission.

Funding

Research reported in this publication was supported, in part, by the National Institutes of Health’s National Cancer Institute, Grant Numbers U54CA202995, U54CA202997, and U54CA203000. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, 833 S. Wood St. MC 871, Chicago, IL, 60612, USA

    Connie H. Yan, Chandler Coleman, Nadia A. Nabulsi & Gregory S. Calip

  2. Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA

    Brian C.-H. Chiu

  3. Section of Hematology Oncology, Boston University School of Medicine, Boston, MA, USA

    Naomi Y. Ko

  4. Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA

    Kent Hoskins

Authors
  1. Connie H. Yan
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  2. Chandler Coleman
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  3. Nadia A. Nabulsi
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  4. Brian C.-H. Chiu
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  7. Gregory S. Calip
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Contributions

All authors contributed to the study conception, design, data collection, and analyses. The first draft of the manuscript was written by CHY, and all authors reviewed and commented on previous versions of the manuscript. All authors read and provided approval of the final manuscript.

Corresponding author

Correspondence to Gregory S. Calip.

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Conflict of interest

At the time of submission, Gregory S. Calip reports employment with Flatiron Health, Inc, which is an independent subsidiary of the Roche Group and has received research funding from Pfizer, Inc. awarded to the University of Illinois at Chicago for work unrelated to this study. Chandler Coleman reports current employment with AbbVie, Inc. at the time of submission. All other authors have no conflict of interest to declare.

Ethical approval

The data used in the study were de-identified and compliant with the Health Insurance Portability and Accountability Act (HIPAA). This study was determined to be exempt by the Institutional Review Board of the University of Illinois at Chicago.

Informed consent

The Institutional Review Board of the University of Illinois at Chicago determined this study to be exempt from obtaining informed consent from individual participants.

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Yan, C.H., Coleman, C., Nabulsi, N.A. et al. Associations between frailty and cancer-specific mortality among older women with breast cancer. Breast Cancer Res Treat 189, 769–779 (2021). https://doi.org/10.1007/s10549-021-06323-3

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