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Jeon M, Lee SH, Jang JY, Kim S. How can we approach preoperative frailty and related factors in patients with cancer? A scoping review. Nurs Open 2024; 11:e2216. [PMID: 38890786 PMCID: PMC11187855 DOI: 10.1002/nop2.2216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 03/05/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
AIM To identify factors related to preoperative frailty in patients with cancer and map the tools that measure frailty. DESIGN A Scoping review. METHODS This scoping review based on Arksey and O'Malley's framework. Articles from CINAHL, PubMed, EMBASE, and PsycINFO databases published between January 2011 and April 2021. The searched keywords were concepts related to 'cancer', 'frailty' and 'measurement'. RESULTS While 728 records were initially identified, 24 studies were eventually selected. Research on frailty was actively conducted between 2020 and 2021. Factors related to preoperative frailty were age (22.9%), sex (11.4%), body mass index (11.4%) and physical status indicators (54.3%). The most common result of preoperative frailty was postoperative complications (35.0%). 24 instruments were used to measure frailty. IMPLICATIONS FOR PATIENT CARE Selecting an appropriate preoperative frailty screening tool can help improve patient postoperative treatment outcomes. IMPACT There are many instruments for assessing preoperative frailty, each evaluating a multi-dimensional feature. We identified the frailty screening tools used today, organized the factors that affect frailty, and explored the impact of frailty. Identifying and organizing frailty measurement tools will enable appropriate evaluation. REPORTING METHOD PRISMA-ScR. PATIENT CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Misun Jeon
- College of Nursing and Brain Korea 21 FOUR ProjectYonsei UniversitySeoulSouth Korea
| | - Sang Hwa Lee
- College of Nursing and Brain Korea 21 FOUR ProjectYonsei UniversitySeoulSouth Korea
| | - Ji Yoon Jang
- College of Nursing and Brain Korea 21 FOUR ProjectYonsei UniversitySeoulSouth Korea
| | - Sanghee Kim
- College of Nursing & Mo‐Im Kim Nursing Research InstituteYonsei UniversitySeoulSouth Korea
- Department of Artificial Intelligence, College of ComputingYonsei UniversitySeoulSouth Korea
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2
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Casile M, Albrand G, Lebecque B, Besombes J, Bourgne C, Pereira B, Saugues S, Jamot C, Hermet E, Berger MG. Value of combining biological age with assessment of individual frailty to optimize management of cancer treated with targeted therapies: model of chronic myeloid leukemia treated with tyrosine kinase inhibitors (BIO-TIMER trial). BMC Cancer 2024; 24:661. [PMID: 38816821 PMCID: PMC11140958 DOI: 10.1186/s12885-024-12415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND In the era of targeted therapies, the influence of aging on cancer management varies from one patient to another. Assessing individual frailty using geriatric tools has its limitations, and is not appropriate for all patients especially the youngest one. Thus, assessing the complementary value of a potential biomarker of individual aging is a promising field of investigation. The chronic myeloid leukemia model allows us to address this question with obvious advantages: longest experience in the use of tyrosine kinase inhibitors, standardization of therapeutic management and response with minimal residual disease and no effect on age-related diseases. Therefore, the aim of the BIO-TIMER study is to assess the biological age of chronic myeloid leukemia or non-malignant cells in patients treated with tyrosine kinase inhibitors and to determine its relevance, in association or not with individual frailty to optimize the personalised management of each patient. METHODS The BIO-TIMER study is a multi-center, prospective, longitudinal study aiming to evaluate the value of combining biological age determination by DNA methylation profile with individual frailty assessment to personalize the management of chronic myeloid leukemia patients treated with tyrosine kinase inhibitors. Blood samples will be collected at diagnosis, 3 months and 12 months after treatment initiation. Individual frailty and quality of life will be assess at diagnosis, 6 months after treatment initiation, and then annually for 3 years. Tolerance to tyrosine kinase inhibitors will also be assessed during the 3-year follow-up. The study plans to recruit 321 patients and recruitment started in November 2023. DISCUSSION The assessment of individual frailty should make it possible to personalize the treatment and care of patients. The BIO-TIMER study will provide new data on the role of aging in the management of chronic myeloid leukemia patients treated with tyrosine kinase inhibitors, which could influence clinical decision-making. TRIAL REGISTRATION ClinicalTrials.gov , ID NCT06130787; registered on November 14, 2023.
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Affiliation(s)
- Mélanie Casile
- Biological Hematology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
- EA 7453 CHELTER, University of Clermont Auvergne, Clermont-Ferrand, France.
| | - Gilles Albrand
- Geriatric Evaluation and Management unit, Antoine Charial Hospital, Francheville, Lyon, France
| | - Benjamin Lebecque
- Biological Hematology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- EA 7453 CHELTER, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Joévin Besombes
- Biological Hematology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- EA 7453 CHELTER, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Céline Bourgne
- Biological Hematology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- EA 7453 CHELTER, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Clinical Research and Innovation Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sandrine Saugues
- Biological Hematology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Biological Resources Centre - Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Caroline Jamot
- Biological Hematology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Biological Resources Centre - Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Eric Hermet
- Clinical Hematology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc G Berger
- Biological Hematology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- EA 7453 CHELTER, University of Clermont Auvergne, Clermont-Ferrand, France
- Biological Resources Centre - Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Wang S, Huang D, Liu X, Tang Q, Xi C, Ma Y, Liu H, Chen X, Shen A, Di M, Qiang W, Du X. Development and validation of a prediction model for frailty in breast cancer patients with extended survival. Support Care Cancer 2024; 32:393. [PMID: 38809281 DOI: 10.1007/s00520-024-08501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Breast cancer (BC) patients with extended survival show a higher incidence of frailty. This study aimed to develop and validate a novel model combining sociodemographic factors (SF) and disease-related factors (DRF) to identify frailty in BC patients with extended survival. METHODS This cross-sectional study examined data from 1167 patients admitted to a large urban academic medical centre. Three types of predictive models were constructed in the training set (817 patients): the SF model, the DRF model, and the SF + DRF model (combined model). The model performance and effectiveness were assessed using receiver operating characteristic (ROC) curves, calibration plots and decision curves analysis (DCA). Then the model was subsequently validated on the validation set. RESULTS The incidence of frailty in BC patients with extended survival was 35.8%. We identified six independent risk factors including age, health status, chemotherapy, endocrine therapy, number of comorbidities and oral medications. Ultimately, we constructed an optimal model (combined model C) for frailty. The predictive model showed significantly high discriminative accuracy in the training set AUC: 0.754, (95% CI, 0.719-0.789; sensitivity: 76.8%, specificity: 62.2%) and validation set AUC: 0.805, (95% CI, 0.76-0.85), sensitivity: 60.8%, specificity: 87.1%) respectively. A prediction nomogram was constructed for the training and validation sets. Calibration and DCA were performed, which indicated that the clinical model presented satisfactory calibration and clinical utility. Ultimately, we implemented the prediction model into a mobile-friendly web application that provides an accurate and individualized prediction for BC. CONCLUSIONS The present study demonstrated that the prevalence of frailty in BC patients with extended survival was 35.8%. We developed a novel model for screening frailty, which may provide evidence for frailty screening and prevention.
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Affiliation(s)
- Shurui Wang
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei Province, People's Republic of China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Difei Huang
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei Province, People's Republic of China
| | - Xiaofeng Liu
- Keio University Shonan Fujisawa Campus Graduate School of Health Management, Fujisawa-Shi, Kanagawa, Japan
| | - Qiang Tang
- The Second Affiliated Hospital of Zhejiang University School Medicine, Hang Zhou, China
| | - Chenxi Xi
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yixin Ma
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huan Liu
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xing Chen
- Oncology Treatment Center, Affiliated Hospital of Jiangsu University, Jiangsu, China
| | - Aomei Shen
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- School of Nursing, Peking University, Haidian District, 38 Xueyuan Road, Beijing, China
| | - Maojun Di
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei Province, People's Republic of China.
| | - Wanmin Qiang
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
| | - Xian Du
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei Province, People's Republic of China.
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Guida JL, Hyun G, Belsky DW, Armstrong GT, Ehrhardt MJ, Hudson MM, Green PA, Robison LL, Streck BP, Tonorezos ES, Yasui Y, Wilson CL, Wang Z, Ness KK. Associations of seven measures of biological age acceleration with frailty and all-cause mortality among adult survivors of childhood cancer in the St. Jude Lifetime Cohort. NATURE CANCER 2024; 5:731-741. [PMID: 38553617 PMCID: PMC11139608 DOI: 10.1038/s43018-024-00745-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
Survivors of childhood cancer may experience accelerated biological aging, resulting in premature frailty and death. We used seven measures of biological age in the St. Jude Lifetime (SJLIFE) Cohort to compare biological age acceleration between the SJLIFE Cohort and the third United States National Health and Nutrition Examination Survey controls, explore trajectories of biological age according to cancer treatment and type, and test associations of biological age acceleration with frailty and death (mean follow-up of 26.5 years) among survivors. Survivors of cancer aged 5% faster per year and measured, on average, 0.6-6.44 years biologically older compared to controls and 5-16 years biologically older compared to age-matched individuals at the population level. Survivors treated with hematopoietic cell transplant and vinca alkaloid chemotherapy evidenced the fastest trajectories of biological aging. Biologically, older and faster-aging survivors consistently and robustly had a higher risk of frailty and died earlier than those with slower biological aging, suggesting a potential opportunity to intervene on excess aging.
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Affiliation(s)
- Jennifer L Guida
- Division of Cancer Control and Populations Sciences, National Cancer Institute, Rockville, MD, USA
| | - Geehong Hyun
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel W Belsky
- Department of Epidemiology and Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Paige A Green
- Division of Cancer Control and Populations Sciences, National Cancer Institute, Rockville, MD, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Brennan P Streck
- Division of Cancer Control and Populations Sciences, National Cancer Institute, Rockville, MD, USA
| | - Emily S Tonorezos
- Office of Cancer Survivorship, National Cancer Institute, Rockville, MD, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Carroll JE, Mandelblatt JS. Disparities, aging and childhood cancer. NATURE CANCER 2024; 5:695-696. [PMID: 38553616 DOI: 10.1038/s43018-024-00737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Affiliation(s)
- Judith E Carroll
- Department of Psychiatry & Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior University of California, Los Angeles, Los Angeles, CA, USA.
- The Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown Lombardi Institute for Cancer and Aging Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Capozza SJ. 'Patient Is Otherwise Healthy'. JCO Oncol Pract 2024; 20:453-455. [PMID: 38315942 DOI: 10.1200/op.23.00798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Affiliation(s)
- Scott J Capozza
- Smilow Cancer Hospital Adult Cancer Survivorship Clinic at Yale Cancer Center, New Haven, CT
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Wang S, El Jurdi N, Thyagarajan B, Prizment A, Blaes AH. Accelerated Aging in Cancer Survivors: Cellular Senescence, Frailty, and Possible Opportunities for Interventions. Int J Mol Sci 2024; 25:3319. [PMID: 38542292 PMCID: PMC10970400 DOI: 10.3390/ijms25063319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 06/02/2024] Open
Abstract
The population of cancer survivors has markedly increased due to the rapid improvements in cancer treatment. However, cancer survivors experience accelerated aging, which leads to chronic diseases and other age-related conditions, such as frailty. Those conditions may persist years after cancer diagnosis and treatment. Cellular senescence, a hallmark of aging, is one of the mechanisms that contribute to accelerated aging in cancer survivors. Several aging measures, including measures based on clinical markers and biomarkers, have been proposed to estimate the aging process, and some of them have shown associations with mortality and frailty in cancer survivors. Several anti-aging interventions, including lifestyle changes and anti-aging drugs, have been proposed. Future research, particularly in large-scale studies, is needed to determine the efficiency of these aging measures and anti-aging interventions before considering their application in clinics. This review focuses on the mechanisms of cellular senescence and accelerated aging in cancer survivors, assessment of the aging process using clinical markers and biomarkers, and the high prevalence of frailty in that population, as well as possible opportunities for anti-aging interventions. A deeper understanding of aging measures and anti-aging interventions in cancer survivors will contribute to the development of effective strategies to mitigate accelerated aging in cancer survivors and improve their quality of life.
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Affiliation(s)
- Shuo Wang
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Najla El Jurdi
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Anna Prizment
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Anne H. Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA
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Gonzalo-Encabo P, Vasbinder A, Bea JW, Reding KW, Laddu D, LaMonte MJ, Stefanick ML, Kroenke CH, Jung SY, Shadyab AH, Naughton MJ, Patel MI, Luo J, Banack HR, Sun Y, Simon MS, Dieli-Conwright CM. Low physical function Post-Cancer diagnosis is associated with higher mortality risk in postmenopausal women. J Natl Cancer Inst 2024:djae055. [PMID: 38449287 DOI: 10.1093/jnci/djae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/22/2024] [Accepted: 02/18/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Postmenopausal women with cancer experience an accelerated physical dysfunction beyond that expected through aging alone due to cancer and its treatments. The aim of this study is to determine whether declines in physical function after cancer diagnosis are associated with all-cause mortality and cancer-specific mortality. METHODS This prospective cohort study included 8,068 postmenopausal women enrolled in the Women's Health Initiative (WHI) who were diagnosed with cancer and had physical function assessed within 1-year of cancer diagnosis. Self-reported physical function was measured using the 10-item physical function subscale of the RAND 36-Item Health Survey. Cause of death was determined by medical record review with central adjudication and linkage to the National Death Index. Death was adjudicated through February 2022. RESULTS Over a median follow-up of 7.7 years from cancer diagnosis 3,316 (41.1%) women died. Our results showed that for every 10% decline in the physical function score after cancer diagnosis, all-cause mortality and cancer-specific mortality were significantly reduced by 12% (HR, 0.88; 95% CI, 0.87 to 0.89) and (HR, 0.88; 95%CI, 0.86 to 0.91), respectively. Further categorical analyses showed a significant dose-response relationship between post-diagnosis physical function categories and mortality outcomes (trend test P < .001), where the median survival time for women in the lowest physical function quartile was 9.1 (8.6, 10.6) years compared to 18.4 (15.8, 22.0) years for women in the highest physical function quartile. CONCLUSION Postmenopausal women with low physical function after cancer diagnosis may be at higher risk of mortality from all causes and cancer-related mortality.
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Affiliation(s)
- Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Área de Educación Física y Deportiva, Madrid, España
| | - Alexi Vasbinder
- University of Washington School of Nursing, Seattle, WA, USA
| | - Jennifer W Bea
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, USA
| | - Kerryn W Reding
- University of Washington School of Nursing, Seattle, WA, USA
| | - Deepika Laddu
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Michael J LaMonte
- Department of Epidemiology & Environmental Health, University at Buffalo-SUNY, Buffalo, NY, USA
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, CA, USA
| | - Candyce H Kroenke
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
- Kaiser Permanente School of Medicine, Pasadena, CA, USA
| | - Su Yon Jung
- Department of Epidemiology, Fielding School of Public Health, Translational Sciences Section, School of Nursing, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Michelle J Naughton
- Division of Cancer Prevention & Control, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States; VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Hailey R Banack
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yangbo Sun
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, 38163, TN, USA
| | - Michael S Simon
- Department of Oncology, Karmanos Cancer Institute at Wayne State University, Detroit, MI, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Rio CJ, Saligan LN, Li X, Crouch A, Von Ah D. Correlates of frailty in older female cancer survivors. J Geriatr Oncol 2024; 15:101682. [PMID: 38104481 PMCID: PMC10922550 DOI: 10.1016/j.jgo.2023.101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/31/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Cancer survivors are at risk of frailty because of cancer and its treatment. Understanding the factors that increase the risk of frailty is an important aspect of cancer care for the development of interventions to prevent or manage frailty, thus improving cancer survival and overall quality of life of cancer survivors. This study aimed to identify demographic, clinical, and psychosocial correlates of frailty in older, female cancer survivors. MATERIALS AND METHODS This is a sub-study focusing on the exploratory aim of a larger cross-sectional study (NURS-IIR-IUSCC-0748). A total of 213 female cancer survivors aged 59-87 years old were included from the parent study in the current analysis. Frailty, the primary outcome, was measured using the Tilburg Frailty Indicator scale. The independent variables were age, relationship status, clinical stage of cancer, treatment type, comorbidity, depression, affect, optimism, stress, and social support. Stepwise linear regression modeling identified the independent variables that were significantly associated with frailty. RESULTS The final regression model revealed that high patient-reported stress and depression, comorbidity, not being married or living with a partner, and low positive affect were significantly associated with worsening frailty in this population. DISCUSSION Understanding the context of frailty is important for the design of interventions that target factors known to be associated with frailty in older cancer survivors. Further validation with a larger and a more diverse sample from a broad spectrum of sociodemographic and clinical population would fully account for the multiple independent variables influencing frailty in cancer survivors.
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Affiliation(s)
- Carielle Joy Rio
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States of America
| | - Leorey N Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States of America.
| | - Xiaobai Li
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, MD, United States of America
| | - Adele Crouch
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Diane Von Ah
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
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Armenian SH, Chao C. Burden of Morbidity and Mortality in Adolescent and Young Adult Cancer Survivors. J Clin Oncol 2024; 42:735-742. [PMID: 37983585 DOI: 10.1200/jco.23.01751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023] Open
Abstract
There are an estimated 650,00 survivors of adolescent and young adult (AYA) cancers in the United States, a number that is expected to markedly increase in the coming decades. The recognition of the potential for some cancer treatments to affect the health of patients for many years after the initial diagnosis has prompted investigators to examine the evolving burden of late morbidity and mortality in AYAs with cancer after treatment completion. Studies in large international cohorts of AYA cancer survivors have now shown that the burden of late effects in survivors treated during the past four decades is substantial, affecting the health and well-being of the survivor, health systems' preparedness to meet their health care needs in the future, and societal economic costs that are largely affected by loss of productivity. We highlight the unique considerations for AYA cancer survivors, identify gaps in knowledge for future research, and provide an overview of emerging efforts to mitigate late effects in these survivors. Ongoing multidisciplinary bench-to-bedside collaborations are critical to understanding the biology of late effects in AYA cancer survivors and to developing personalized interventions to mitigate them. The growing population of AYA cancer survivors makes it imperative that these efforts extend across the cancer care continuum, which will allow survivors to ultimately live to their fullest potential.
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Affiliation(s)
- Saro H Armenian
- Department of Pediatrics, City of Hope, Duarte, CA
- Division of Outcomes Research, Department of Population Science, City of Hope, Duarte, CA
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
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11
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Shakya S, Silva SG, McConnell ES, McLaughlin SJ, Cary MP. Structural determinants and cardiometabolic typologies related to frailty in community-dwelling older adults. Arch Gerontol Geriatr 2024; 117:105171. [PMID: 37688920 DOI: 10.1016/j.archger.2023.105171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/20/2023] [Accepted: 08/26/2023] [Indexed: 09/11/2023]
Abstract
Frailty is a geriatric syndrome linked to adverse outcomes. Co-occurring cardiometabolic factors increase frailty risk; however, their distinct combinations (typologies) associated with frailty are unclear. We aimed to identify subgroups of older adults with distinct cardiometabolic typologies and characterize their relationship with structural determinants and frailty to inform tailored approaches to prevent and delay frailty. This study was cross-sectional design and included 7984 community-dwelling older adults (65+ years) enrolled in the Health and Retirement Study (2006 and 2008). Latent class analysis was performed using seven cardiometabolic indicators (abdominal obesity, obesity, low high-density lipoprotein; and elevated blood pressure, blood sugar, total cholesterol, C-reactive protein). Frailty was indicated by ≥3 features (weakness, slowness, fatigue, low physical activity, unintentional weight loss). Logistic regression was used to examine the relationship between structural determinants (gender, race/ethnicity, and education), cardiometabolic typologies, and frailty. Three cardiometabolic subgroups were identified: insulin-resistant (n = 3547), hypertensive dyslipidemia (n = 1246), and hypertensive (n = 3191). Insulin-resistant subgroup members were more likely to be female, non-Hispanic Black, and college non-graduates; hypertensive dyslipidemia subgroup members were more likely to be non-Hispanic Others and report high school education; and hypertensive subgroup members were more likely to be male and college educated (p≤.05). Frailty risk was higher for females, Hispanic or Non-Hispanic Black older adults, and those with lower education (p≤.001). Frailty risk was greater in the insulin-resistant compared to the other subgroups (both aOR=2.0, both p<.001). Findings highlight a need to design tailored interventions targeting cardiometabolic typologies to prevent and delay frailty.
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Affiliation(s)
- Shamatree Shakya
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
| | - Susan G Silva
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States
| | - Eleanor S McConnell
- Department of Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Durham, NC, United States
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, OH, United States
| | - Michael P Cary
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States
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12
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Budamagunta V, Kumar A, Rani A, Manohar Sindhu S, Yang Y, Zhou D, Foster TC. Senolytic treatment alleviates doxorubicin-induced chemobrain. Aging Cell 2024; 23:e14037. [PMID: 38225896 PMCID: PMC10861213 DOI: 10.1111/acel.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 01/17/2024] Open
Abstract
Doxorubicin (Dox), a widely used treatment for cancer, can result in chemotherapy-induced cognitive impairments (chemobrain). Chemobrain is associated with inflammation and oxidative stress similar to aging. As such, Dox treatment has also been used as a model of aging. However, it is unclear if Dox induces brain changes similar to that observed during aging since Dox does not readily enter the brain. Rather, the mechanism for chemobrain likely involves the induction of peripheral cellular senescence and the release of senescence-associated secretory phenotype (SASP) factors and these SASP factors can enter the brain to disrupt cognition. We examined the effect of Dox on peripheral and brain markers of aging and cognition. In addition, we employed the senolytic, ABT-263, which also has limited access to the brain. The results indicate that plasma SASP factors enter the brain, activating microglia, increasing oxidative stress, and altering gene transcription. In turn, the synaptic function required for memory was reduced in response to altered redox signaling. ABT-263 prevented or limited most of the Dox-induced effects. The results emphasize a link between cognitive decline and the release of SASP factors from peripheral senescent cells and indicate some differences as well as similarities between advanced age and Dox treatment.
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Affiliation(s)
- Vivekananda Budamagunta
- Department of Neuroscience, McKnight Brain InstituteUniversity of FloridaGainesvilleFloridaUSA
- Genetics and Genomics Graduate Program, Genetics InstituteUniversity of FloridaGainesvilleFloridaUSA
- Department of Pharmacodynamics, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Ashok Kumar
- Department of Neuroscience, McKnight Brain InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Asha Rani
- Department of Neuroscience, McKnight Brain InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Sahana Manohar Sindhu
- Genetics and Genomics Graduate Program, Genetics InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Yang Yang
- Department of Pharmacodynamics, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Daohong Zhou
- Department of Pharmacodynamics, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- Department of Biochemistry and Structural BiologyUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Thomas C. Foster
- Department of Neuroscience, McKnight Brain InstituteUniversity of FloridaGainesvilleFloridaUSA
- Genetics and Genomics Graduate Program, Genetics InstituteUniversity of FloridaGainesvilleFloridaUSA
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13
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Rosen-Lang Y, Zoubi S, Cialic R, Orenstein T. Using voice biomarkers for frailty classification. GeroScience 2024; 46:1175-1179. [PMID: 37480417 PMCID: PMC10828289 DOI: 10.1007/s11357-023-00872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023] Open
Abstract
Clinicians use the patient's voice intuitively to evaluate general health and frailty. Voice is an emerging health indicator but has been scarcely studied in the context of frailty. This study explored voice parameters as possible predictors of frailty in older adults. Fifty-three participants over 70 years old were recruited from rehabilitation wards at a tertiary medical center. Participants' frailty was assessed using Rockwood frailty index and they were classified as most-frail (n = 33, 68%) or less-frail (n = 20, 32%). Participants were recorded counting from 1 to 10 and backwards using a smartphone recording application. The following voice biomarkers were derived: peak and average volume, peak/average volume ratio, pauses' total length, and pause length standard deviation. The most-frail group had a higher peak volume/average volume ratio (p = 0.03) and greater variance in lengths of pauses between speech segments (p = 0.002). These parameters indicate greater speech irregularity in the most-frail, compared to the less-frail. The most-frail group also had a longer total duration of pauses (p = 0.02). No statistically significant difference was found in peak and average volume (p = 0.75 and 0.39). Most-frail participants' speech had different characteristics, compared to participants in the less-frail group. This is a first step to developing an AI-based frailty assessment tool that can assist in identifying our most vulnerable patients.
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Affiliation(s)
- Yael Rosen-Lang
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Saad Zoubi
- Geriatric Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ron Cialic
- Geriatric Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Tal Orenstein
- Geriatric Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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14
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Gabbard J, Nur S, Levine BJ, Lycan TW, Pajewski N, Frechman E, Callahan KE, Klepin H, McLouth LE. The Association Between an Electronic Health Record (EHR)-Embedded Frailty Index and Patient-Reported Outcomes Among Patients with Metastatic Non-Small-Cell Lung Cancer on Immunotherapy: A Brief Report. Am J Hosp Palliat Care 2023:10499091231223964. [PMID: 38133583 PMCID: PMC11192858 DOI: 10.1177/10499091231223964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background: While frailty is a well-established predictor of overall mortality among patients with metastatic non-small cell lung cancer (mNSCLC), its association with patient-reported outcomes is not well-characterized. The goal of this study was to examine the association between an electronic frailty index (eFI) score and patient-reported outcome measures along with prognostic awareness among patients with mNSCLC receiving immunotherapy. Methods: In a cross-sectional study, patients with mNSCLC who were on immunotherapy completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) and the National Cancer Institute Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). We utilized bivariate analyses to compare quality of life, symptoms, supportive services, and prognostic awareness among 3 groups defined by e-frailty status. Results: Sixty patients (mean age 62.5 years, 75% Caucasian, 60% women) participated. Most patients were pre-frail (68%), with 13% being frail and 18% non-frail. Pre-frail and frail patients had significantly lower physical function scores (mean 83.9 fit vs 74.8 pre-frail vs 60.0 frail, P = .04) and higher rates of self-reported pain (75% frail vs 41.5% pre-frail vs 18.2% fit; P = .04) compared to non-frail patients. We found no differences in palliative referral rates. Conclusion: Pre-frail and frail mNSCLC patients identified by the eFI have higher rates of pain and physical functional impairments than non-frail patients. These findings highlight the importance of emphasizing preventive interventions targeting social needs, functional limitations, and pain management, especially among pre-frail patients to reduce further decline.
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Affiliation(s)
- Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Saadia Nur
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Beverly J. Levine
- Department of Social Sciences and Health Policy, School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Thomas W. Lycan
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nicholas Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erica Frechman
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E. Callahan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Heidi Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Laurie E. McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Zeidan RS, McElroy T, Rathor L, Martenson MS, Lin Y, Mankowski RT. Sex differences in frailty among older adults. Exp Gerontol 2023; 184:112333. [PMID: 37993077 DOI: 10.1016/j.exger.2023.112333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.
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Affiliation(s)
- Rola S Zeidan
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Taylor McElroy
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Laxmi Rathor
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Matthew S Martenson
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Yi Lin
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Robert T Mankowski
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
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16
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Yu SM, Hsu CC, Hsueh SW, Hung CY, Lu CH, Yeh KY, Wang HM, Lin SY, Hung YS, Chou WC. Frailty assessment by two screening instruments in non-elderly patients with head and neck cancer. Oral Oncol 2023; 147:106621. [PMID: 37931492 DOI: 10.1016/j.oraloncology.2023.106621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Frailty assessment is often overlooked in non-elderly patients with cancer, possibly due to the lack of an effective frailty screening tool. This study aimed to evaluate the performance of two modern frailty screening tools, the Flemish version of the Triage Risk Screening Tool (fTRST) and the modified 5-Item Frailty Index (mFI-5), compared to the gold standard comprehensive geriatric assessment (GA) among non-elderly patients with head and neck cancer (HNC). METHODS We prospectively included 354 consecutive patients aged < 65 years with newly diagnosed HNC scheduled for definitive concurrent chemoradiotherapy (CCRT) at three academic hospitals in Taiwan between January 2020 and December 2022. Frailty assessment using the GA, fTRST, and mFI-5 was performed in all patients to evaluate the relationship between frailty and treatment outcomes. RESULTS The prevalence of frailty was 27.1%, 37.0%, and 42.4% based on GA, mFI-5, and fTRST, respectively. mFI-5 and fTRST demonstrated good predictive value in identifying frail patients compared to the GA. Patients with frailty, as defined by GA, mFI-5, and fTRST, exhibited higher risks of treatment-related complications, incomplete treatment, and poorer baseline quality of life (QoL). However, only GA showed significant prognostic value for overall survival. CONCLUSIONS Frailty assessment using fTRST and mFI-5 is valuable for predicting treatment-related adverse events, treatment tolerance, and QoL in non-elderly patients with HNC. Incorporating frailty assessment into the management of non-elderly cancer patients can aid in the identification of high-risk individuals. However, the performance of these tools varies, highlighting the need for further validation and refinement.
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Affiliation(s)
- Shao-Ming Yu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chung Hsu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Wen Hsueh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chang-Hsien Lu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Kun-Yun Yeh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Hung-Ming Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shinn-Yn Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Liu F, Peng Y, Wang P, Qiao Y, Si C, Wang X, Zhang M, Chen L, Song F. Associations of physical frailty with incidence and mortality of overall and site-specific cancers: A prospective cohort study from UK biobank. Prev Med 2023; 177:107742. [PMID: 37866694 DOI: 10.1016/j.ypmed.2023.107742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Evidence regarding the role of physical frailty in cancer-related outcomes is limited. We aimed to examine the association of frailty with cancer incidence and mortality risk. METHODS This prospective study included 348,144 participants free of cancer at baseline from the UK Biobank. Frailty phenotypes (non-frail, pre-frail, and frail) were constructed from 5 components: weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength. The outcome was incidence and mortality of overall and cite-specific cancers. Cox proportional hazard regression was used to estimate the association of frailty phenotypes with cancer incidence and mortality risk. RESULTS A total of 43,304 incident cancer cases and 10,152 cancer deaths were documented during a median of 12.0 years of follow-up. For overall cancer, compared with non-frailty, the incidence risk increased by 4% for pre-frailty and 11% for frailty, and the mortality risk increased by 11% for pre-frailty and 39% for frailty. Frailty phenotypes were also dose-dependently associated with a higher risk of incidence and mortality of some site-specific cancers (including liver and lung), with significant sex differences. We observed a synergetic association of frailty phenotypes and smoking with overall cancer incidence and mortality risk. CONCLUSIONS Frailty phenotypes contributed significantly to a higher risk of overall and some site-specific cancers incidence and mortality in a stepwise manner or within individual categories. Future studies are warranted to emphasize the identification, management and prevention of frailty in the whole population and complements of lifestyle-targeted interventions such as quitting smoking.
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Affiliation(s)
- Fubin Liu
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University, Cancer Institute and Hospital, Tianjin 300060, China
| | - Yu Peng
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University, Cancer Institute and Hospital, Tianjin 300060, China
| | - Peng Wang
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University, Cancer Institute and Hospital, Tianjin 300060, China
| | - Yating Qiao
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University, Cancer Institute and Hospital, Tianjin 300060, China
| | - Changyu Si
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University, Cancer Institute and Hospital, Tianjin 300060, China
| | - Xixuan Wang
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University, Cancer Institute and Hospital, Tianjin 300060, China
| | - Ming Zhang
- Comprehensive Management Department of Occupational Health, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen 518020, China
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Fangfang Song
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University, Cancer Institute and Hospital, Tianjin 300060, China.
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18
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Pu J, Zhou W, Zeng W, Shang S. Long-term trajectories of frailty phenotype in older cancer survivors: a nationally representative longitudinal cohort study. Age Ageing 2023; 52:afad190. [PMID: 37897808 DOI: 10.1093/ageing/afad190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Frailty is a dynamic process associated with adverse health outcomes. However, little is known about the long-term trajectories of frailty in older cancer survivors. OBJECTIVES To describe the trajectories of frailty phenotype over time amongst older cancer survivors and examine the socio-demographic and health-related predictors of different trajectories. DESIGN Population-based longitudinal cohort study. SETTING Community-dwelling older adults in the United States. SUBJECTS 1,763 older adults who were diagnosed with cancer from the National Health and Ageing Trends Study. METHODS Frailty was assessed by the Fried Frailty Phenotype. The group-based trajectory model was used to identify the trajectories of frailty. Multinomial logistic regression analyses were used to examine the socio-demographic and health-related predictors of different trajectories. RESULTS Three frailty trajectories were identified; 52.8% of older cancer survivors had a sustained low risk of frailty over time, 25.0% had a low frailty risk at baseline but the risk increased steadily, and 22.3% had a high frailty risk with a slight change in the observed period. Older cancer survivors were at a high-risk frailty trajectory if they were older, female, African American, had lower education status, had lower annual income, were underweight or obese, self-rated poorer health, had more chronic conditions and difficulties with activities of daily living (ADL), and had worse cognitive functions (P < 0.05). CONCLUSIONS Long-term frailty trajectories in older cancer survivors are heterogeneous. This study helps identify patients at high risk of sustained or deteriorating frailty and has the potential to inform targeted frailty management strategies addressing modifiable factors identified (e.g. body mass index, ADL).
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Affiliation(s)
- Junlan Pu
- School of Nursing, Peking University, Beijing 100191, China
| | - Weijiao Zhou
- School of Nursing, Peking University, Beijing 100191, China
| | - Wen Zeng
- School of Nursing, Peking University, Beijing 100191, China
- Neurology Department, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Shaomei Shang
- School of Nursing, Peking University, Beijing 100191, China
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19
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Westrick AC, Langa KM, Eastman M, Ospina-Romero M, Mullins MA, Kobayashi LC. Functional aging trajectories of older cancer survivors: a latent growth analysis of the US Health and Retirement Study. J Cancer Surviv 2023; 17:1499-1509. [PMID: 35218520 PMCID: PMC9411262 DOI: 10.1007/s11764-022-01185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to identify prototypical functional aging trajectories of US cancer survivors aged 50 and older, overall and stratified by sociodemographic and health-related characteristics. METHODS Data were from 2986 survivors of a first incident cancer diagnosis (except non-melanoma skin cancer) after age 50 in the population representative U.S. Health and Retirement Study from 1998-2016. Cancer diagnoses, episodic memory function, and activity of daily living (ADL) limitations were assessed at biennial study interviews. Using time of cancer diagnosis as the baseline, we used group-based trajectory modeling to identify trajectories of memory function and ADL limitations following diagnosis. RESULTS We identified five memory loss trajectories (high: 8.4%; medium-high: 18.3%; medium-low: 21.5%; low: 25.5%; and, very low: 26.2%), and four ADL limitation trajectories (high/increasing limitations: 18.7%; medium limitations: 18.7%; low limitations: 8.14%; no limitations: 60.0). The high memory loss and high/increasing ADL limitation trajectories were both characterized by older age, being female (52% for memory, 58.9% for ADL), having lower pre-cancer memory scores, and a higher prevalence of pre-cancer comorbidities including stroke (30.9% for memory and 29.7% for ADL), hypertension (64.7% for memory and 69.8 for ADL), and depressive symptoms. In joint analyses, we found that generally those with higher memory were more likely to have fewer ADL limitations and vice versa. CONCLUSION Older cancer survivors experience heterogeneous trajectories of functional aging that are largely characterized by comorbidities prior to diagnosis. IMPLICATION FOR CANCER SURVIVORS Results can help identify older cancer survivors at increased risk for accelerated functional decline.
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Affiliation(s)
- Ashly C Westrick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Kenneth M Langa
- Institute for Healthcare Policy and Innovations, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Marisa Eastman
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Monica Ospina-Romero
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Ann Arbor, USA
| | - Megan A Mullins
- Center for Improving Patient and Population Health, University of Michigan, Ann Arbor, MI, USA
- Cancer Control and Population Sciences Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
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20
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Rentscher KE, Bethea TN, Zhai W, Small BJ, Zhou X, Ahles TA, Ahn J, Breen EC, Cohen HJ, Extermann M, Graham DM, Jim HS, McDonald BC, Nakamura ZM, Patel SK, Root JC, Saykin AJ, Van Dyk K, Mandelblatt JS, Carroll JE. Epigenetic aging in older breast cancer survivors and noncancer controls: preliminary findings from the Thinking and Living with Cancer Study. Cancer 2023; 129:2741-2753. [PMID: 37259669 PMCID: PMC10659047 DOI: 10.1002/cncr.34818] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Cancer and its treatments may accelerate aging in survivors; however, research has not examined epigenetic markers of aging in longer term breast cancer survivors. This study examined whether older breast cancer survivors showed greater epigenetic aging than noncancer controls and whether epigenetic aging related to functional outcomes. METHODS Nonmetastatic breast cancer survivors (n = 89) enrolled prior to systemic therapy and frequency-matched controls (n = 101) ages 62 to 84 years provided two blood samples to derive epigenetic aging measures (Horvath, Extrinsic Epigenetic Age [EEA], PhenoAge, GrimAge, Dunedin Pace of Aging) and completed cognitive (Functional Assessment of Cancer Therapy-Cognitive Function) and physical (Medical Outcomes Study Short Form-12) function assessments at approximately 24 to 36 and 60 months after enrollment. Mixed-effects models tested survivor-control differences in epigenetic aging, adjusting for age and comorbidities; models for functional outcomes also adjusted for racial group, site, and cognitive reserve. RESULTS Survivors were 1.04 to 2.22 years biologically older than controls on Horvath, EEA, GrimAge, and DunedinPACE measures (p = .001-.04) at approximately 24 to 36 months after enrollment. Survivors exposed to chemotherapy were 1.97 to 2.71 years older (p = .001-.04), and among this group, an older EEA related to worse self-reported cognition (p = .047) relative to controls. An older epigenetic age related to worse physical function in all women (p < .001-.01). Survivors and controls showed similar epigenetic aging over time, but Black survivors showed accelerated aging over time relative to non-Hispanic White survivors. CONCLUSION Older breast cancer survivors, particularly those exposed to chemotherapy, showed greater epigenetic aging than controls that may relate to worse outcomes. If replicated, measurement of biological aging could complement geriatric assessments to guide cancer care for older women.
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Affiliation(s)
- Kelly E. Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee WI
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Traci N. Bethea
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Wanting Zhai
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL
| | - Xingtao Zhou
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Tim A. Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Elizabeth C. Breen
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
| | | | - Deena M.A. Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | | | - Brenna C. McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Zev M. Nakamura
- Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, NC
| | | | - James C. Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Kathleen Van Dyk
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | | | - Judith E. Carroll
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
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21
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Schmitt A, Weidner K, Rusnak J, Ruka M, Egner-Walter S, Mashayekhi K, Tajti P, Ayoub M, Akin I, Behnes M, Schupp T. Age-related outcomes in patients with cardiogenic shock stratified by etiology. J Geriatr Cardiol 2023; 20:555-566. [PMID: 37675262 PMCID: PMC10477585 DOI: 10.26599/1671-5411.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND As a result of improved and novel treatment strategies, the spectrum of patients with cardiovascular disease is consistently changing. Overall, those patients are typically older and characterized by increased burden with comorbidities. Limited data on the prognostic impact of age in cardiogenic shock (CS) is available. Therefore, this study investigates the prognostic impact of age in patients with CS. METHODS From 2019 to 2021, consecutive patients with CS of any cause were included. The prognostic value of age (i.e., 60-80 years and > 80 years) was investigated for 30-day all-cause mortality. Spearman's correlations, Kaplan-Meier analyses, as well as multivariable Cox proportional regression analyses were performed for statistics. Subsequent risk assessment was performed based on the presence or absence of CS related to acute myocardial infarction (AMI). RESULTS 223 CS patients were included with a median age of 77 years (interquartile range: 69-82 years). No significant difference in 30-day all-cause mortality was observed for both age-groups (54.6% vs. 63.4%, log-rank P = 0.169; HR = 1.273, 95% CI: 0.886-1.831, P = 0.192). In contrast, when analyzing subgroups stratified by CS-etiology, AMI-related CS patients of the group > 80 years showed an increased risk of 30-day all-cause mortality (78.1% vs. 60.0%, log-rank P = 0.032; HR = 1.635, 95% CI: 1.000-2.673, P = 0.050), which was still evident after multivariable adjustment (HR = 2.072, 95% CI: 1.174-3.656, P = 0.012). CONCLUSIONS Age was not associated with 30-day all-cause mortality in patients with CS of mixed etiology. However, increasing age was shown to be a significant predictor of increased mortality-risk in the subgroup of patients presenting with AMI-CS.
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Affiliation(s)
- Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Marinela Ruka
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, Lahr, Germany
| | - Péter Tajti
- Gottsegen György National Cardiovascular Center, Budapest, Hungary
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum-Bad Oeynhausen, Bad Oeynhausen, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
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22
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Coffman EM, Smitherman AB, Willis EA, Ward DS, Tate DF, Valle CG. Frailty and comorbidities among young adult cancer survivors enrolled in an mHealth physical activity intervention trial. J Cancer Surviv 2023:10.1007/s11764-023-01448-4. [PMID: 37610479 PMCID: PMC10884352 DOI: 10.1007/s11764-023-01448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE The physical frailty phenotype identifies individuals at risk for adverse health outcomes but has rarely been assessed among young adult cancer survivors (YACS). This study describes frailty status among YACS participating in a physical activity (PA) intervention trial. METHODS YACS were categorized at baseline using the 5-item FRAIL scale: fatigue; weight loss; illness; ambulation; resistance. Chi-square tests compared frailty and non-cancer comorbidities by characteristics. Prevalence rates (PRs) for the independent associations between characteristics, frailty, and comorbidities were estimated using modified Poisson regression models. RESULTS Among 280 YACS (82% female; mean (M) age = 33.4 ± 4.8 years, M=3.7 ± 2.4 years post-diagnosis), 11% frail, 17% prefrail; the most frequent criteria were fatigue (41%), resistance (38%), and ambulation (14%). Compared to BMI < 25, higher BMI was associated with increased likelihood of frailty (BMI 25-30, PR: 2.40, 95% CI: 1.38-4.17; BMI > 30, PR: 2.95, 95% CI: 1.71-5.08). Compared to 0, ≥ 30 min/week of moderate-to-vigorous PA was associated with reduced frailty (PR: 0.39, 95% CI: 0.25-0.60). Most YACS (55%) reported ≥ 1 comorbidity, most frequently depression (38%), thyroid condition (19%), and hypertension (10%). Comorbidities were more common for women (59% vs. 37%) and current/former smokers (PR: 1.71, 95% CI: 1.29-2.28). CONCLUSION Prevalence of frailty and comorbidities in this sample was similar to other YACS cohorts and older adults without cancer and may be an indicator of accelerated aging and increased risk for poor outcomes. IMPLICATIONS FOR CANCER SURVIVORS Assessment of frailty may help identify YACS at increased risk for adverse health outcomes.
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Affiliation(s)
- Erin M Coffman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Andrew B Smitherman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Erik A Willis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA
| | - Deborah F Tate
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Carmina G Valle
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Suite 136, Chapel Hill, NC, 27514, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
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23
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Prochownik EV, Wang H. Lessons in aging from Myc knockout mouse models. Front Cell Dev Biol 2023; 11:1244321. [PMID: 37621775 PMCID: PMC10446843 DOI: 10.3389/fcell.2023.1244321] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
Despite MYC being among the most intensively studied oncogenes, its role in normal development has not been determined as Myc-/- mice do not survival beyond mid-gestation. Myc ± mice live longer than their wild-type counterparts and are slower to accumulate many age-related phenotypes. However, Myc haplo-insufficiency likely conceals other important phenotypes as many high-affinity Myc targets genes continue to be regulated normally. By delaying Myc inactivation until after birth it has recently been possible to study the consequences of its near-complete total body loss and thus to infer its normal function. Against expectation, these "MycKO" mice lived significantly longer than control wild-type mice but manifested a marked premature aging phenotype. This seemingly paradoxical behavior was potentially explained by a >3-fold lower lifetime incidence of cancer, normally the most common cause of death in mice and often Myc-driven. Myc loss accelerated the accumulation of numerous "Aging Hallmarks", including the loss of mitochondrial and ribosomal structural and functional integrity, the generation of reactive oxygen species, the acquisition of genotoxic damage, the detrimental rewiring of metabolism and the onset of senescence. In both mice and humans, normal aging in many tissues was accompaniued by the downregulation of Myc and the loss of Myc target gene regulation. Unlike most mouse models of premature aging, which are based on monogenic disorders of DNA damage recognition and repair, the MycKO mouse model directly impacts most Aging Hallmarks and may therefore more faithfully replicate the normal aging process of both mice and humans. It further establishes that the strong association between aging and cancer can be genetically separated and is maintained by a single gene.
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Affiliation(s)
- Edward V. Prochownik
- Division of Hematology/Oncology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
- The Department of Microbiology and Molecular Genetics, UPMC, Pittsburgh, PA, United States
- The Hillman Cancer Center of UPMC, Pittsburgh, PA, United States
- The Pittsburgh Liver Research Center, UPMC, Pittsburgh, PA, United States
| | - Huabo Wang
- Division of Hematology/Oncology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
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24
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Noto S. Perspectives on Aging and Quality of Life. Healthcare (Basel) 2023; 11:2131. [PMID: 37570372 PMCID: PMC10418952 DOI: 10.3390/healthcare11152131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
The aging of the world's population and the health problems accompanying it are becoming increasingly severe. Healthcare policies in developed countries focus on how to prevent and treat diseases associated with aging and how to maintain quality of life. Typical age-related diseases include deafness, cataracts, osteoarthritis, chronic obstructive pulmonary disease, diabetes mellitus, and dementia. Although the mechanisms by which these diseases develop differ, they are all caused by the accumulation of molecular and cellular damage over time. In addition, age-related diseases can cause a decline in physical and mental functions and the ability to perform activities of daily living, as well as the loss of roles in society and a sense of fulfillment in life. Therefore, there is a need for treatment and measures to accurately grasp and maintain quality of life. This review aims to introduce areas and representative papers expected to be contributed to the special issue of "Aging and Quality of Life".
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Affiliation(s)
- Shinichi Noto
- Department of Rehabilitation, Niigata University of Health and Welfare, Niigata 9503198, Japan
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25
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Wennberg AM, Matthews A, Talbäck M, Ebeling M, Ek S, Feychting M, Modig K. Frailty Among Breast Cancer Survivors: Evidence From Swedish Population Data. Am J Epidemiol 2023; 192:1128-1136. [PMID: 36883906 PMCID: PMC10326604 DOI: 10.1093/aje/kwad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/19/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Incidence and survival of breast cancer, the most common cancer among women, have been increasing, leaving survivors at risk of aging-related health conditions. In this matched cohort study, we examined frailty risk with the Hospital Frailty Risk Score among breast cancer survivors (n = 34,900) and age-matched comparison subjects (n = 290,063). Women born in 1935-1975, registered in the Swedish Total Population Register (1991-2015), were eligible for inclusion. Survivors had a first breast cancer diagnosis in 1991-2005 and survived ≥5 years after initial diagnosis. Death date was determined by linkage to the National Cause of Death Registry (through 2015). Cancer survivorship was weakly associated with frailty (subdistribution hazard ratio (SHR) = 1.04, 95% confidence interval (CI): 1.00, 1.07). In age-stratified models, those diagnosed at younger ages (<50 years) had higher risk of frailty (SHR = 1.12, 95% CI: 1.00, 1.24) than those diagnosed at ages 50-65 (SHR = 1.03, 95% CI: 0.98, 1.07) or >65 (SHR = 1.09, 95% CI: 1.02, 1.17) years. Additionally, there was increased risk of frailty for diagnoses in 2000 or later (SHR = 1.15, 95% CI: 1.09, 1.21) compared with before 2000 (SHR = 0.97, 95% CI: 0.93, 1.17). This supports work from smaller samples showing that breast cancer survivors have increased frailty risk, particularly when diagnosed at younger ages.
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Affiliation(s)
- Alexandra M Wennberg
- Correspondence to Dr. Alexandra Wennberg, Unit of Epidemiology, Institutet of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77 Stockholm, Sweden (e-mail: )
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26
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Depoorter V, Vanschoenbeek K, Decoster L, Silversmit G, Debruyne PR, De Groof I, Bron D, Cornélis F, Luce S, Focan C, Verschaeve V, Debugne G, Langenaeken C, Van Den Bulck H, Goeminne JC, Teurfs W, Jerusalem G, Schrijvers D, Petit B, Rasschaert M, Praet JP, Vandenborre K, Milisen K, Flamaing J, Kenis C, Verdoodt F, Wildiers H. Long-term health-care utilisation in older patients with cancer and the association with the Geriatric 8 screening tool: a retrospective analysis using linked clinical and population-based data in Belgium. THE LANCET. HEALTHY LONGEVITY 2023; 4:e326-e336. [PMID: 37327806 DOI: 10.1016/s2666-7568(23)00081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Little evidence is available on the long-term health-care utilisation of older patients with cancer and whether this is associated with geriatric screening results. We aimed to evaluate long-term health-care utilisation among older patients after cancer diagnosis and the association with baseline Geriatric 8 (G8) screening results. METHODS For this retrospective analysis, we included data from three cohort studies for patients (aged ≥70 years) with a new cancer diagnosis who underwent G8 screening between Oct 19, 2009 and Feb 27, 2015, and who survived more than 3 months after G8 screening. The clinical data were linked to cancer registry and health-care reimbursement data for long-term follow-up. The occurrence of outcomes (inpatient hospital admissions, emergency department visits, use of intensive care, contacts with general practitioner [GP], contacts with a specialist, use of home care, and nursing home admissions) was assessed in the 3 years after G8 screening. We assessed the association between outcomes and baseline G8 score (normal score [>14] or abnormal [≤14]) using adjusted rate ratios (aRRs) calculated from Poisson regression and using cumulative incidence calculated as a time-to-event analysis with the Kaplan-Meier method. FINDINGS 7556 patients had a new cancer diagnosis, of whom 6391 patients (median age 77 years [IQR 74-82]) met inclusion criteria and were included. 4110 (64·3%) of 6391 patients had an abnormal baseline G8 score (≤14 of 17 points). In the first 3 months after G8 screening, health-care utilisation peaked and then decreased over time, with the exception of GP contacts and home care days, which remained high throughout the 3-year follow-up period. Compared with patients with a normal baseline G8 score, patients with an abnormal baseline G8 score had more hospital admissions (aRR 1·20 [95% CI 1·15-1·25]; p<0·0001), hospital days (1·66 [1·64-1·68]; p<0·0001), emergency department visits (1·42 [1·34-1·52]; p<0·0001), intensive care days (1·49 [1·39-1·60]; p<0·0001), general practitioner contacts (1·19 [1·17-1·20]; p<0·0001), home care days (1·59 [1·58-1·60]; p<0·0001), and nursing home admissions (16·7% vs 3·1%; p<0·0001) in the 3-year follow-up period. At 3 years, of the 2281 patients with a normal baseline G8 score, 1421 (62·3%) continued to live at home independently and 503 (22·0%) had died. Of the 4110 patients with an abnormal baseline G8 score, 1057 (25·7%) continued to live at home independently and 2191 (53·3%) had died. INTERPRETATION An abnormal G8 score at cancer diagnosis was associated with increased health-care utilisation in the subsequent 3 years among patients who survived longer than 3 months. FUNDING Stand up to Cancer, the Flemish Cancer Society.
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Affiliation(s)
| | | | - Lore Decoster
- Department of Medical Oncology, Vrije Universiteit Brussel, University Hospitals Brussels, Brussels, Belgium
| | | | - Philip R Debruyne
- Division of Medical Oncology, Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; Medical Technology Research Centre, School of Life Sciences, Anglia Ruskin University, Cambridge, UK; School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Inge De Groof
- Department of Geriatric Medicine, Iridium Network Antwerp, Sint-Augustinus Cancer Center, Wilrijk, Belgium
| | - Dominique Bron
- Department of Hematology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Frank Cornélis
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sylvie Luce
- Department of Medical Oncology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Focan
- Department of Oncology, Clinique CHC MontLégia, Liège, Belgium
| | - Vincent Verschaeve
- Department of Medical Oncology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Gwenaëlle Debugne
- Department of Geriatric Medicine, Centre Hospitalier de Mouscron, Mouscron, Belgium
| | | | | | - Jean-Charles Goeminne
- Department of Medical Oncology, Centre Hospitalier Universitaire UCL-Namur, Namur, Belgium
| | - Wesley Teurfs
- Department of Medical Oncology, ZNA Stuivenberg, Antwerp, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, Centre Hospitalier Universitaire Sart Tilman, Liège University, Liège, Belgium
| | - Dirk Schrijvers
- Department of Medical Oncology, ZNA Middelheim, Antwerp, Belgium
| | - Bénédicte Petit
- Department of Medical Oncology, Centre Hospitalier Jolimont, La Louvière, Belgium
| | - Marika Rasschaert
- Department of Medical Oncology, University Hospital Antwerp, Edegem, Belgium
| | - Jean-Philippe Praet
- Department of Geriatric Medicine, Centre Hospitalier Universitaire St-Pierre, Free Universities Brussels, Brussels, Belgium
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Cindy Kenis
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Freija Verdoodt
- Research Department, Belgian Cancer Registry, Brussels, Belgium
| | - Hans Wildiers
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
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27
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Lao J, Su M, Zhang J, Liu L, Zhou S, Yao N. Frailty and medical financial hardship among older adults with cancer in the United States. Front Oncol 2023; 13:1202575. [PMID: 37456241 PMCID: PMC10344591 DOI: 10.3389/fonc.2023.1202575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023] Open
Abstract
Background Little is known about the association between frailty level and medical financial hardship among older adults with cancer. This study aims to describe the prevalence of frailty and to identify its association with medical financial hardship among older cancer survivors in the United States. Methods The National Health Interview Survey (NHIS; 2019-2020) was used to identify older cancer survivors (n = 3,919). Both the five-item (Fatigue, Resistance, Ambulation, Illnesses, and Low weight-for-height) FRAIL and the three-domain (Material, Psychological, and Behavioral) medical financial hardship questions were constructed based on the NHIS questionnaire. Multivariable logistic models were used to identify the frailty level associated with financial hardship and its intensity. Results A total of 1,583 (40.3%) older individuals with cancer were robust, 1,421 (35.9%) were pre-frail, and 915 (23.8%) were frail. Compared with robust cancer survivors in adjusted analyses, frail cancer survivors were more likely to report issues with material domain (odds ratio (OR) = 3.19, 95%CI: 2.16-4.69; p < 0.001), psychological domain (OR = 1.47, 95%CI: 1.15-1.88; p < 0.001), or behavioral domain (ORs ranged from 2.19 to 2.90, all with p < 0.050), and greater intensities of financial hardship. Conclusion Both pre-frail and frailty statuses are common in the elderly cancer survivor population, and frail cancer survivors are vulnerable to three-domain financial hardships as compared with robust cancer survivors. Ongoing attention to frailty highlights the healthy aging of older survivors, and efforts to targeted interventions should address geriatric vulnerabilities during cancer survivorship.
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Affiliation(s)
- Jiahui Lao
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan, Shandong, China
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
| | - Jiajun Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
| | - Li Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shengyu Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
| | - Nengliang Yao
- Home Centered Care Institute, Schaumburg, IL, United States
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Coffman EM, Smitherman AB, Willis EA, Ward DS, Tate DF, Valle CG. Frailty and Comorbidities Among Young Adult Cancer Survivors Enrolled in an mHealth Physical Activity Intervention Trial. RESEARCH SQUARE 2023:rs.3.rs-3111745. [PMID: 37461600 PMCID: PMC10350202 DOI: 10.21203/rs.3.rs-3111745/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Purpose: The physical frailty phenotype identifies individuals at risk for adverse health outcomes but has rarely been assessed among young adult cancer survivors (YACS). This study describes frailty status among YACS participating in a PA intervention trial. Methods: YACS were categorized by frailty status at baseline using the 5-item FRAIL index: fatigue; weight loss; illness; ambulation; resistance. Chi-square tests compared frailty and comorbidities by characteristics. Prevalence rates (PRs) for the independent associations between characteristics, frailty, and comorbidities were estimated using modified Poisson regression models. Results: Among 280 YACS (82% female, M=33.4±4.8 years, M=3.7±2.4 years post-diagnosis), 14% had frailty, and 24% prefrailty; the most frequent criteria were fatigue (70%), resistance (38%), and ambulation (14%). Compared to BMI <25, higher BMI (BMI 25-30, PR: 1.65, 95% CI: 1.02-2.65; BMI > 30, PR: 2.36, 95% CI: 1.46-3.81) was associated with increased frailty status. Compared to 0, 1-50 minutes/week of moderate-to-vigorous PA was associated with reduced frailty (PR: 0.62, 95% CI: 0.43-0.90). Most YACS (55%) reported > 1 comorbidity, most frequently depression (38%), thyroid condition (19%), and hypertension (10%). Men were less likely to report comorbidities (PR: 0.63, 95% CI: 0.42-0.93). Current/former smokers (PR: 1.29, 95% CI: 1.01-1.64) were more likely to have comorbidities. Conclusion: Prevalence of frailty and comorbidities in this sample was similar to other YACS cohorts and may be an indicator of accelerated aging and increased risk for poor outcomes. Implications for Cancer Survivors: Assessment of frailty may help identify YACS at risk for adverse health outcomes.
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Zhu M, Wang T, Sun J, Zhou Z, Wang D, Teng L. Heterogeneity of vulnerability and taste changes in older cancer patients undergoing chemotherapy: a latent class analysis. Support Care Cancer 2023; 31:392. [PMID: 37310497 DOI: 10.1007/s00520-023-07862-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Taste changes and vulnerability are commonly co-occurring in oncology patients undergoing chemotherapy. However, few studies explored the association and the inter-individual variability of these two conditions. This study aimed to identify heterogeneous subtypes of vulnerability and taste changes in older cancer patients undergoing chemotherapy, and explore individuals' characteristics and risk factors. METHODS In this cross-sectional study, the latent class analysis (LCA) was conducted to identify the heterogeneous subgroups of patients with distinct vulnerability and taste change profiles. Differences in sociodemographic and clinical characteristics among the subpopulation were evaluated using parametric and nonparametric tests. Multinomial logistic regression was performed to investigate predictors of taste change-vulnerability subgroup classification. RESULTS Three subgroups of those older cancer survivors were identified from the LCA: Class 1 (27.5%)-"Moderate taste change and low vulnerability", Class 2 (29.0%)-"Low taste change and moderate vulnerability", Class 3 (43.5%)-"High taste change and high vulnerability". 98.9% of Class 3 reported taste changes and 54.0% reported vulnerability. Results from multinomial logistic regression indicated that patients in Class 3 were more likely to report experiencing mouth dryness and high blood pressure, and have received more than 3 cycles of chemotherapy. CONCLUSION The findings could provide new insights into the association between taste changes and vulnerability in older cancer adults receiving chemotherapy. Identifying different latent classes of taste changes and vulnerability would be helpful for developing interventions tailored to the heterogeneous survivors.
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Affiliation(s)
- Min Zhu
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Teng Wang
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Jun Sun
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Zhou Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Danhui Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Liping Teng
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214122, Jiangsu, China.
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Plonski NM, Chen C, Dong Q, Qin N, Song N, Parikh HM, Shelton K, Finch ER, Easton J, Mulder H, Zhang J, Neale G, Walker E, Wang H, Krull K, Ness KK, Hudson MM, Robison LL, Li Q, Williams A, Wang Z. Epigenetic Age in Peripheral Blood Among Children, Adolescent, and Adult Survivors of Childhood Cancer. JAMA Netw Open 2023; 6:e2310325. [PMID: 37115548 PMCID: PMC10148192 DOI: 10.1001/jamanetworkopen.2023.10325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Importance Certain cancer therapies are risk factors for epigenetic age acceleration (EAA) among survivors of childhood cancer, and EAA is associated with chronic health conditions (CHCs). However, small numbers of younger survivors (aged <20 years) previously evaluated have limited the ability to calculate EAA among this age group. Objective To evaluate the change rate of epigenetic age (EA) and EAA in younger compared with older survivors and the possible association of EAA with early-onset obesity (aged <20 years), severity/burden of CHCs, and late mortality (>5 years from cancer diagnosis). Design, Setting, and Participants Study participants were from the St Jude Lifetime Cohort, initiated in 2007 with ongoing follow-up. The present study was conducted from April 17, 2022, to March 23, 2023. Survivors in this cohort of European ancestry with DNA methylation data were included. Cross-sectional annual changes in EA and EAA were compared across 5 different chronologic age groups: age 0 to 9 (children), 10 to 19 (adolescents), 20 to 34 (younger adults), 35 to 49 (middle-aged adults), and greater than or equal to 50 (older adults) years. Logistic regression evaluated the association between EAA and early-onset obesity or severity/burden of CHCs. Cox proportional hazards regression assessed the association between EAA and late mortality. Main Outcomes and Measures Early-onset obesity, severity/burden of CHCs (graded using the Common Terminology Criteria for Adverse Events (grade 1, mild; 2, moderate; 3, severe/disabling; 4, life-threatening) and were combined into high vs low severity/burden based on frequency and grade), and late mortality were the outcomes based on follow-up until April 2020. Expanded DNA methylation profiling increased the number of survivors younger than 20 years (n = 690). Epigenetic age was calculated primarily using the Levine clock, and EAA was derived from least squares regression of EA against chronologic age and was standardized to a z score (Levine EEA). Results Among 2846 participants (median age, 30.3 [IQR, 9.3-41.5] years; 53% males), the cross-sectional annual change in EA_Levine was higher in children (1.63 years) and adolescents (1.14 years), and the adjusted least-squares mean of Levine EEA was lower in children (-0.22 years) and older adults (-1.70 years). Each 1-SD increase in Levine EEA was associated with increased risk of developing early-onset obesity (odds ratio [OR], 1.46; 95% CI, 1.19-1.78), high severity/burden of CHCs (OR, 1.13; 95% CI, 1.03-1.24), and late mortality (hazard ratio, 1.75; 95% CI, 1.35-2.26). Conclusions and Relevance The findings of this study suggest that EAA measured in children and adolescent survivors of childhood cancer is associated with early-onset obesity, severity/burden of all CHCs, and late mortality. Evaluating EAA may help identify survivors of childhood cancer at increased risk for early-onset obesity, morbidity in general, and mortality.
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Affiliation(s)
- Noel-Marie Plonski
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Cheng Chen
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
- School of Public Health, Shanghai Jiaotong University, Shanghai, China
| | - Qian Dong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Na Qin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Nan Song
- College of Pharmacy, Chungbuk National University, Cheongju, Korea
| | - Hemang M Parikh
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa
| | - Kyla Shelton
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Emily R Finch
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - John Easton
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Heather Mulder
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jinghui Zhang
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Geoffrey Neale
- Hartwell Center, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Emily Walker
- Hartwell Center, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Hui Wang
- School of Public Health, Shanghai Jiaotong University, Shanghai, China
| | - Kevin Krull
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Qian Li
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - AnnaLynn Williams
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, Tennessee
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Cao X, Yang Z, Li X, Chen C, Hoogendijk EO, Zhang J, Yao NA, Ma L, Zhang Y, Zhu Y, Zhang X, Du Y, Wang X, Wu X, Gill TM, Liu Z. Association of frailty with the incidence risk of cardiovascular disease and type 2 diabetes mellitus in long-term cancer survivors: a prospective cohort study. BMC Med 2023; 21:74. [PMID: 36829175 PMCID: PMC9951842 DOI: 10.1186/s12916-023-02774-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 02/09/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Comorbidities among cancer survivors remain a serious healthcare burden and require appropriate management. Using two widely used frailty indicators, this study aimed to evaluate whether frailty was associated with the incidence risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) among long-term cancer survivors. METHODS We included 13,388 long-term cancer survivors (diagnosed with cancer over 5 years before enrolment) free of CVD and 6101 long-term cancer survivors free of T2DM, at the time of recruitment (aged 40-69 years), from the UK Biobank. Frailty was assessed by the frailty phenotype (FP_Frailty, range: 0-5) and the frailty index (FI_Frailty, range: 0-1) at baseline. The incident CVD and T2DM were ascertained through linked hospital data and primary care data, respectively. The associations were examined using Cox proportional hazards regression models. RESULTS Compared with non-frail participants, those with pre-frailty (FP_Frailty [met 1-2 of the components]: hazard ratio [HR]=1.18, 95% confidence interval [CI]: 1.05, 1.32; FI_Frailty [0.10< FI ≤0.21]: HR=1.51, 95% CI: 1.32, 1.74) and frailty (FP_Frailty [met ≥3 of the components]: HR=2.12, 95% CI: 1.73, 2.60; FI_Frailty [FI >0.21]: HR=2.19, 95% CI: 1.85, 2.59) had a significantly higher risk of CVD in the multivariable-adjusted model. A similar association of FI_Frailty with the risk of incident T2DM was observed. We failed to find such an association for FP_Frailty. Notably, the very early stage of frailty (1 for FP_Frailty and 0.1-0.2 for FI_Frailty) was also positively associated with the risk of CVD and T2DM (FI_Frailty only). A series of sensitivity analyses confirmed the robustness of the findings. CONCLUSIONS Frailty, even in the very early stage, was positively associated with the incidence risk of CVD and T2DM among long-term cancer survivors, although discrepancies existed between frailty indicators. While the validation of these findings is required, they suggest that routine monitoring, prevention, and interventive programs of frailty among cancer survivors may help to prevent late comorbidities and, eventually, improve their quality of life. Especially, interventions are recommended to target those at an early stage of frailty when healthcare resources are limited.
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Affiliation(s)
- Xingqi Cao
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Zhejiang, 310058, Hangzhou, China
| | - Zhenqing Yang
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Zhejiang, 310058, Hangzhou, China
| | - Xueqin Li
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Zhejiang, 310058, Hangzhou, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100000, China
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health research Institute, Amsterdam UMC - location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, the Netherlands
| | - Jingyun Zhang
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Zhejiang, 310058, Hangzhou, China
| | - Nengliang Aaron Yao
- Home Centered Care Institute, Schaumburg, IL, USA
- Center For Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Section of Geriatrics, University of Virginia, Charlottesville, VA, USA
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
- Beijing Geriatric Healthcare Center, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Yawei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yong Zhu
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Yuxian Du
- Bayer Healthcare Pharmaceuticals U.S. LLC, Whippany, NJ, 07981, USA
| | - Xiaofeng Wang
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Human Phenome Institute, Fudan University, Shanghai, 200433, China
- National Clinical Research Center for Ageing and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xifeng Wu
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Zhejiang, 310058, Hangzhou, China
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Zuyun Liu
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Zhejiang, 310058, Hangzhou, China.
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Mislang ARA, Mangoni AA, Molga A, Jena S, Koczwara B. New horizons in managing older cancer survivors: complexities and opportunities. Age Ageing 2023; 52:7024515. [PMID: 36735848 DOI: 10.1093/ageing/afad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/20/2022] [Indexed: 02/05/2023] Open
Abstract
Older adults represent a growing population amongst cancer survivors who require specific consideration given the complex and largely unknown interactions between cancer-related concerns and age-related conditions. The increasing use of geriatric assessment (GA) has enabled oncologists to appropriately assess older patients' overall health status, personalise anti-cancer treatment and improve survival. However, whilst current research and practice focus on improving the management of older adults with cancer in the acute setting, the progress in the field of survivorship research in geriatric oncology is lagging. As cancer survivorship is a continuum, planning for a healthy survivorship should start at the time of cancer diagnosis. GA can play an important role in identifying potential survivorship issues and optimising delivery of survivorship care. A goal-directed, patient-focused geriatric survivorship care plan that involves a multidisciplinary team provides a framework for a personalised delivery of survivorship care in this patient group and there is a need for tailored interventions that support self-management and care integration. Research on the impact of cancer and its treatment on geriatric-specific outcomes needs to be prioritised through global initiatives to encompass a diverse and heterogenous population of adult cancer survivors.
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Affiliation(s)
- Anna R A Mislang
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Angela Molga
- Department of Clinical Pharmacology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Swatee Jena
- Department of Rehabilitation Medicine, Division of Rehabilitation, Aged Care and Palliative Care, Flinders Medical Centre, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Farrell A, Castro T, Nalubola S, Lakhi N. Trauma-related falls in an urban geriatric population: predictive risk factors for poorer clinical outcomes. Inj Epidemiol 2023; 10:7. [PMID: 36717881 PMCID: PMC9887835 DOI: 10.1186/s40621-023-00418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The aim of this study was to elucidate associations between polypharmacy, types of medications, and geriatric comorbidities to identify predictive risk factors for poorer clinical outcomes following trauma-related falls in the geriatric population. Nearly 80% of trauma-related hospital admissions in the older adult population are secondary to falls, accounting for 3 million emergency department visits annually. Numerous studies have demonstrated associations between falls, polypharmacy, and other geriatric comorbidities, but studies outlining predictive risk factors for poor clinical outcomes are lacking. METHODS A retrospective cohort study of 1087 patients ≥ 65 years old who presented to Level 1 Trauma Center after a trauma-related fall. Comorbidities, current medication, demographic information, and clinical outcomes were identified to ascertain predictive risk factors for poorer clinical outcomes. Variables were assessed for statistical significance on unadjusted analysis. Variables found to be significant were entered into a multivariable logistic regression model to test for adjusted associations, with p < 0.05 as statistically significant, and presented as adjusted odds ratios with 95% confidence intervals. RESULTS Polypharmacy ≥ 4 medications (aOR 2.38 (1.10-5.15), p < .028) was an independent predictor of hospital readmission within 30 days. Chronic kidney disease, male gender, and Asian race had an increased association with ICU admission. History of malignancy (aOR 3.65 (1.62-8.19), p < .002) and chronic kidney disease (aOR 2.56 (1.11-5.96), p < .027) were independent predictors of 30-day mortality. CONCLUSIONS Polypharmacy, chronic renal disease, malignancy history, male gender, and Asian race had an increased association of adverse clinical outcomes after falls in the geriatric population. Critical evaluation of patients with these risk factors may be needed to mitigate risk in this population.
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Affiliation(s)
- Alexander Farrell
- grid.430773.40000 0000 8530 6973Touro University College of Osteopathic Medicine, Middletown, NY USA
| | - Taylor Castro
- grid.260914.80000 0001 2322 1832College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY USA
| | - Shreya Nalubola
- grid.260917.b0000 0001 0728 151XSchool of Medicine, New York Medical College, Valhalla, NY USA
| | - Nisha Lakhi
- grid.260917.b0000 0001 0728 151XSchool of Medicine, New York Medical College, Valhalla, NY USA ,grid.416977.a0000 0004 0622 3555Department of Trauma Surgery, Richmond University Medical Center, Staten Island, NY USA
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Ekram ARMS, Ryan J, Espinoza SE, Newman AB, Murray AM, Orchard SG, Fitzgerald SM, McNeil JJ, Ernst ME, Woods RL. The Association between Frailty and Dementia-Free and Physical Disability-Free Survival in Community-Dwelling Older Adults. Gerontology 2023; 69:549-560. [PMID: 36617406 PMCID: PMC10238577 DOI: 10.1159/000528984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/22/2022] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Frailty is a common geriatric syndrome that adversely impacts health outcomes. This study examined correlates of physical frailty in healthy community-dwelling older adults and studied the effect of frailty on disability-free survival (DFS), defined as survival free of independence-limiting physical disability or dementia. METHODS This is a post hoc analysis of 19,114 community-dwelling older adults (median age: 74.0 years, interquartile range or IQR: 6.1 years) from Australia and the USA enrolled in the "ASPirin in Reducing Events in the Elderly (ASPREE)" clinical trial. Frailty was assessed using a modified Fried phenotype and a deficit accumulation frailty index (FI) utilizing a ratio score derived from 66 items. Multinomial logistic regression was used to examine the correlates of frailty and Cox regression to analyze the association between frailty and DFS (and its components). RESULTS At study enrollment, 39.0% were prefrail, and 2.2% of participants were frail, according to Fried phenotype. Older age, higher waist circumference, lower education, ethnoracial origin, current smoking, depression, and polypharmacy were associated with prefrailty and frailty according to Fried phenotype and FI. Fried phenotype defined prefrailty and frailty predicted reduced DFS (prefrail: HR: 1.67; 95% CI: 1.50-1.86 and frail: HR: 2.80; 95% CI: 2.27-3.46), affecting each component of DFS including dementia, physical disability, and mortality. Effect sizes were larger, according to FI. CONCLUSION Our study showed that prefrailty is common in community-dwelling older adults initially free of cardiovascular disease, dementia, or independence-limiting physical disability. Prefrailty and frailty significantly reduced disability-free survival. Addressing modifiable correlates, like depression and polypharmacy, might reduce the adverse impact of frailty on dementia-free and physical disability-free survival.
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Affiliation(s)
- A R M Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Sara E Espinoza
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
| | - Anne M Murray
- Hennepin County Medical Center, Berman Center for Outcomes and Clinical Research, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Sharyn M Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, Australia
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Sass D, Parmelee Streck B, Guedes VA, Cooper D, Guida JL, Armstrong TS. Blood-based biomarkers of frailty in solid tumors: a systematic review. Front Public Health 2023; 11:1171243. [PMID: 37213604 PMCID: PMC10193038 DOI: 10.3389/fpubh.2023.1171243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/07/2023] [Indexed: 05/23/2023] Open
Abstract
This review examines the current literature to identify biomarkers of frailty across patients with solid tumors. We conducted the systematic review using preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA). PubMed, Web of Science, and Embase databases were searched from their inception to December 08, 2021, for reports of biomarkers and frailty. Two reviewers independently screened titles, abstracts, and full-text articles. A quality assessment was conducted using NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and Quality Assessment of Case-Control Studies. In total, 915 reports were screened, and 14 full-text articles were included in the review. Most studies included breast tumors, were cross-sectional in design, and measured biomarkers at baseline or pre-treatment. Frailty tools varied with Fried Frailty Phenotype and the geriatric assessment most frequently used. Increased inflammatory parameters (i.e., Interleukin-6, Neutrophil Lymphocyte Ratio, Glasgow Prognostic Score-2) were associated with frailty severity. Only six studies were rated as good quality using assessment ratings. Together, the small number of studies and heterogeneity in frailty assessment limited our ability to draw conclusions from the extant literature. Future research is needed to identify potential target biomarkers of frailty in cancer survivors that may aid in early detection and referral.
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Affiliation(s)
- Dilorom Sass
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Dilorom Sass, ;
| | - Brennan Parmelee Streck
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Vivian A. Guedes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Diane Cooper
- Office of Research Services, National Institutes of Health Library, National Institutes of Health, Bethesda, MD, United States
| | - Jennifer L. Guida
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Terri S. Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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Kruseova J, Zichova A, Eckschlager T. Premature aging in childhood cancer survivors. Oncol Lett 2022; 25:43. [PMID: 36644152 PMCID: PMC9811640 DOI: 10.3892/ol.2022.13629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
Progress in medicine has increased the survival time of children suffering from cancer; >80% of patients survive for at least 5 years from the end of treatment. However, there are late effects of anticancer therapy, which accompany this success. Two-thirds of childhood cancer survivors (CCSs) have at least one late effect (any side effects or complications of anticancer treatment that appear months to years after the completion of treatment), e.g. endocrinopathies, cardiovascular diseases or subsequent cancers, and half of these late effects are serious or life threatening. These late consequences of childhood cancer treatment pose a serious health, social and economic problem. A common mechanism for developing a number of late effects is the onset of premature biological aging, which is associated with the early onset of chronic diseases and death. Cellular senescence in cancer survivors is caused by therapy that can induce chromosomal aberrations, mutations, telomere shortening, epigenetic alterations and mitochondrial dysfunctions. The mechanisms of accelerated aging in cancer survivors have not yet been fully clarified. The measurement of biological age in survivors can help improve the understanding of aging mechanisms and identify risk factors for premature aging. However, to the best of our knowledge, no single marker for the evaluation of biological or functional age is known, so it is therefore necessary to measure the consequences of anticancer treatment using complex assessments. The present review presents an overview of premature aging in CCSs and of the mechanisms involved in its development, focusing on the association of senescence and late effects.
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Affiliation(s)
- Jarmila Kruseova
- Department of Pediatric Hematology and Oncology, 2nd Medical Faculty, Charles University and University Hospital Motol, 150 06 Prague, Czech Republic
| | - Andrea Zichova
- Department of Pediatric Hematology and Oncology, 2nd Medical Faculty, Charles University and University Hospital Motol, 150 06 Prague, Czech Republic
| | - Tomas Eckschlager
- Department of Pediatric Hematology and Oncology, 2nd Medical Faculty, Charles University and University Hospital Motol, 150 06 Prague, Czech Republic,Correspondence to: Professor Tomas Eckschlager, Department of Pediatric Hematology and Oncology, 2nd Medical Faculty, Charles University and University Hospital Motol, V Uvalu 84, 150 06 Prague, Czech Republic, E-mail:
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Skiba MB, Harker G, Guidarelli C, El-Gohary M, Horak F, Roeland EJ, Silbermann R, Hayes-Lattin B, Winters-Stone K. Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study. JMIR Cancer 2022; 8:e39271. [PMID: 36480243 PMCID: PMC9782382 DOI: 10.2196/39271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/29/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. OBJECTIVE We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. METHODS Patients scheduled to receive autoHSCT (78/156, 50%) and controls (78/156, 50%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale-short form), and depression (Center for Epidemiological Studies-Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. RESULTS Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability (ß=.001; P=.005) and heel strike angle (ß=-.088; P=.02). Pain was associated with worse gait speed (ß=-.003; P=.003), stride time variability (ß=.012; P=.02), stride length (ß=-.002; P=.004), and distance traveled (ß=-.786; P=.005). Nausea and pain explained 17% to 33% and 14% to 36% of gait variance measured in patients, respectively. CONCLUSIONS Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term.
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Affiliation(s)
- Meghan B Skiba
- Biobehavioral Health Science Division, College of Nursing, University of Arizona, Tucson, AZ, United States
- The University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Graham Harker
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Carolyn Guidarelli
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Mahmoud El-Gohary
- APDM, Inc, a division of Clario International, Portland, OR, United States
| | - Fay Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
- APDM, Inc, a division of Clario International, Portland, OR, United States
| | - Eric J Roeland
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Rebecca Silbermann
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Brandon Hayes-Lattin
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
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Crowder SL, Hoogland AI, Small BJ, Carpenter KM, Fischer SM, Li D, Kinney AY, Welniak TL, Brownstein N, Reich RR, Hembree T, Extermann M, Kim R, Afiat TP, Berry DL, Turner K, Jim HSL. Associations among frailty and quality of life in older patients with cancer treated with chemotherapy. J Geriatr Oncol 2022; 13:1149-1155. [PMID: 36008271 PMCID: PMC9871794 DOI: 10.1016/j.jgo.2022.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Previous studies have suggested that frailty among older adults with cancer is associated with a variety of negative outcomes, including greater chemotherapy toxicity and worse survival. However, results often do not include patient-reported outcomes, such as quality of life (QOL). The objective of this study was to evaluate frailty prior to receipt of moderately- or highly-emetogenic chemotherapy and acute changes in QOL in patients at least 65 years of age. It was hypothesized that frail patients would report greater declines in QOL. MATERIALS AND METHODS Participants completed questionnaires before receiving their first infusion and again five days later. A 59-item deficit accumulation index score was created at baseline using a modified Rockwood frailty index. QOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The relationship between baseline frailty and QOL was evaluated using a dichotomized deficit accumulation index (frail vs. robust) in repeated measures ANOVA. RESULTS Study participants (n = 151) had a mean age of 72 (SD = 4.5) and 62% were female. Nearly half (42%) were frail at baseline. Frail participants reported worse QOL at baseline compared to robust participants. Frail patients reported smaller declines in overall and physical (p < 0.0001) and emotional (p = 0.006) QOL from baseline to five days after receiving chemotherapy. At five days, frail participants reported better emotional and physical QOL compared to robust participants. DISCUSSION Contrary to expectations, frail patients reported smaller declines in QOL compared to robust patients using a deficit accumulation index. These results can be used to help educate frail patients on what to expect during treatment.
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Affiliation(s)
- Sylvia L Crowder
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Aasha I Hoogland
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Brent J Small
- University of South Florida, School of Aging Studies, United States of America
| | - Kristen M Carpenter
- The Ohio State University, Department of Psychiatry, United States of America
| | - Stacy M Fischer
- University of Colorado Denver, Department of General Internal Medicine, United States of America
| | - Daneng Li
- City of Hope Comprehensive Cancer Center, Department of Medical Oncology and Therapeutics Research, United States of America
| | - Anita Y Kinney
- Rutgers University, Department of Biostatistics and Epidemiology, School of Public Health, United States of America
| | - Taylor L Welniak
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Naomi Brownstein
- Moffitt Cancer Center, Biostatistics and Bioinformatics Shared Resource, United States of America
| | - Richard R Reich
- Moffitt Cancer Center, Biostatistics and Bioinformatics Shared Resource, United States of America
| | - Tim Hembree
- Moffitt Cancer Center, Department of Internal and Hospital Medicine, United States of America
| | - Martine Extermann
- Moffitt Cancer Center, Department of Senior Adult Oncology, United States of America
| | - Richard Kim
- Moffitt Cancer Center, Department of Gastrointestinal Oncology, United States of America
| | - Thanh-Phuong Afiat
- Moffitt Cancer Center, Department of Internal and Hospital Medicine, United States of America
| | - Donna L Berry
- University of Washington, Biobehavioral Nursing and Health Informatics, United States of America
| | - Kea Turner
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Heather S L Jim
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America.
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Duan L, Cui H, Zhang W, Wu S. Symptoms and experiences of frailty in lung cancer patients with chemotherapy: A mixed-method approach. Front Oncol 2022; 12:1019006. [PMID: 36276107 PMCID: PMC9582838 DOI: 10.3389/fonc.2022.1019006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the symptoms and experiences of frailty in lung cancer patients treated with chemotherapy. Methods Quantitative and qualitative research methods were implemented. A total of 302 patients aged > 18 years were recruited by convenience sampling method. Quantitative data were collected through the General Demographic Characteristics questionnaire, the Frailty Phenotype scale, the Cancer Fatigue Scale, the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. Fourteen patients with a score of Frailty Phenotype scale ≥ 3 were drawn and their interviews were thematically analyzed. Results The mean Frailty Phenotype score was (1.63±1.35), suggesting that most of the patients were in pre-frailty conditions. A total of 64 (21.2%) patients were non-frail, 168 (55.6%) patients were pre-frail, 70 (23.2%) patients were frail. The mean CFS, HADS scores, and PSQI scores were (26.86±8.93), (15.42±9.73), and (6.18±4.39), respectively. The Number of chemotherapy times was positively associated with frailty. Anxiety fatigue, depression and poor sleep quality positively correlated with frailty. The qualitative research showed four themes. Theme 1: the most reported symptoms of frailty were physical symptoms and psychological symptoms. Physical symptoms included fatigue, low physical activity, weight loss and poor sleep quality. Psychological symptoms included anxiety, depression and low social activities. Theme 2: frailty was mainly related to lung cancer and chemotherapeutic drugs, which can cause decreased appetite, constipation and altered taste. Theme 3: patients used bad coping strategies to manage the symptoms of frailty. Theme 4: the social support of patients was weak, especially regarding emotional support. Conclusion The most frequent symptoms reported by lung cancer patients treated with chemotherapy were anxiety, fatigue, depression, low physical activity and poor sleep quality. Patients also complained of bad coping strategies and weak support. Medical staff should strengthen the management of frailty, aiming at improving the quality of life in lung cancer patients treated with chemotherapy.
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Affiliation(s)
- Liran Duan
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Huixia Cui
- College of Nursing, Jinzhou Medical University, Jinzhou, China
- *Correspondence: Huixia Cui,
| | - Wenlu Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Shan Wu
- Department of Rheumatology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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Schmitt CA, Wang B, Demaria M. Senescence and cancer - role and therapeutic opportunities. Nat Rev Clin Oncol 2022; 19:619-636. [PMID: 36045302 PMCID: PMC9428886 DOI: 10.1038/s41571-022-00668-4] [Citation(s) in RCA: 171] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/10/2023]
Abstract
Cellular senescence is a state of stable, terminal cell cycle arrest associated with various macromolecular changes and a hypersecretory, pro-inflammatory phenotype. Entry of cells into senescence can act as a barrier to tumorigenesis and, thus, could in principle constitute a desired outcome for any anticancer therapy. Paradoxically, studies published in the past decade have demonstrated that, in certain conditions and contexts, malignant and non-malignant cells with lastingly persistent senescence can acquire pro-tumorigenic properties. In this Review, we first discuss the major mechanisms involved in the antitumorigenic functions of senescent cells and then consider the cell-intrinsic and cell-extrinsic factors that participate in their switch towards a tumour-promoting role, providing an overview of major translational and emerging clinical findings. Finally, we comprehensively describe various senolytic and senomorphic therapies and their potential to benefit patients with cancer. The entry of cells into senescence can act as a barrier to tumorigenesis; however, in certain contexts senescent malignant and non-malignant cells can acquire pro-tumorigenic properties. The authors of this Review discuss the cell-intrinsic and cell-extrinsic mechanisms involved in both the antitumorigenic and tumour-promoting roles of senescent cells, and describe the potential of various senolytic and senomorphic therapeutic approaches in oncology. Cellular senescence is a natural barrier to tumorigenesis; senescent cells are widely detected in premalignant lesions from patients with cancer. Cellular senescence is induced by anticancer therapy and can contribute to some treatment-related adverse events (TRAEs). Senescent cells exert both protumorigenic and antitumorigenic effects via cell-autonomous and paracrine mechanisms. Pharmacological modulation of senescence-associated phenotypes has the potential to improve therapy efficacy and reduce the incidence of TRAEs.
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Affiliation(s)
- Clemens A Schmitt
- Charité Universitätsmedizin Berlin, Medical Department of Hematology, Oncology and Tumour Immunology, and Molekulares Krebsforschungszentrum-MKFZ, Campus Virchow Klinikum, Berlin, Germany.,Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Johannes Kepler University, Linz, Austria.,Kepler University Hospital, Department of Hematology and Oncology, Linz, Austria.,Deutsches Konsortium für Translationale Krebsforschung (German Cancer Consortium), Partner site Berlin, Berlin, Germany
| | - Boshi Wang
- European Research Institute for the Biology of Ageing (ERIBA), University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, the Netherlands
| | - Marco Demaria
- European Research Institute for the Biology of Ageing (ERIBA), University Medical Center Groningen (UMCG), University of Groningen (RUG), Groningen, the Netherlands.
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Beer TM, Shore N, Morgans A, Winters‐Stone K, Wefel JS, George DJ. Functional impact of androgen‐targeted therapy on patients with castration‐resistant prostate cancer. BJUI COMPASS 2022; 3:424-433. [PMID: 36267196 PMCID: PMC9579880 DOI: 10.1002/bco2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/25/2022] [Accepted: 06/12/2022] [Indexed: 12/05/2022] Open
Abstract
Context Second‐generation androgen receptor inhibitors (ARIs) extend metastasis‐free survival, prolong overall survival, and delay symptoms when added to androgen deprivation therapy for the treatment of castration‐sensitive or castration‐resistant prostate cancer (CRPC). However, ARIs may adversely impact physical and cognitive function, thereby decreasing quality of life and prognosis. Objective To evaluate the evidence regarding the potential effects of ARIs on physical and cognitive function and to contextualize how drug‐related adverse effects may influence treatment decisions in CRPC. Evidence acquisition We performed a literature search using MEDLINE from January 1998 to June 2020 using terms relating to prostate cancer, androgen deprivation, and physical and cognitive function. We selected 61 publications for analysis. Evidence synthesis Treatment‐induced deterioration in physical and cognitive function may impair the independence and well‐being of patients with CRPC. Patient‐reported outcomes from clinical trials of ARIs provide quantitative evidence of their impact on these domains, which appears to vary between ARIs, reflecting the different adverse event profiles of these agents. Thus, the risk of physical or cognitive dysfunction may be managed or mitigated by appropriate selection of treatment options. Studies in patients with CRPC have assessed the cognitive effects of ARIs with validated instruments, whereas quantitative analysis of the impact on physical function has been limited. Conclusion Several validated instruments utilized for the assessment of physical and cognitive function in clinical studies have been adapted for clinical practice; however, consensus on the standardization of these assessments is required. Future clinical studies employing validated tools may generate data on the impact of ARIs and guide treatment decisions for patients with CRPC. Patient summary We review the hormonal therapies used to treat men with prostate cancer and the effects they have on physical and cognitive function. We discuss how to measure these effects and how this may assist when choosing treatment.
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Affiliation(s)
- Tomasz M. Beer
- Oregon Health and Science University Knight Cancer Institute Portland Oregon USA
| | - Neal Shore
- Carolina Urologic Research Center Myrtle Beach South Carolina USA
| | | | - Kerri Winters‐Stone
- Oregon Health and Science University Knight Cancer Institute Portland Oregon USA
| | - Jeffrey S. Wefel
- The University of Texas MD Anderson Cancer Center Houston Texas USA
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Jeon M, Jang H, Lim A, Kim S. Frailty and its associated factors among older adults with cancer undergoing chemotherapy as outpatients: A cross-sectional study. Eur J Oncol Nurs 2022; 60:102192. [PMID: 36029615 DOI: 10.1016/j.ejon.2022.102192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Frailty can affect cancer treatment decisions and outcomes. Depression, fatigue, and cognitive impairment often experienced by patients with cancer are expected to be associated with frailty. We aimed to identify frailty and its related factors in older adults with cancer undergoing chemotherapy. METHODS We conducted a cross-sectional descriptive study in a Korean urban tertiary hospital. A structured self-report questionnaire was used including frailty and its related variables and measured heart rate variability (HRV). Multinomial logistic regression was performed to identify the factors related to frailty. RESULTS Data from 124 out of 136 patients with stomach, colorectal, and lung cancers were analyzed. Approximately 90% of the participants were in the pre-frail and frail groups. There were significant differences among the three groups in terms of depression (p = 0.006) and HRV (p = 0.041). The factor associated with higher frailty levels was depression across groups (pre-frail odds ratio (OR): 1.31, 95% CI: 1.14-1.51; frail OR: 1.29, 95% CI: 1.11-1.49). However, only deficits observed or commented on by others were retained as factors significantly associated with higher frailty in the pre-frail group (OR: 2.40, 95% CI: 1.40-4.13). In contrast, increased HRV (OR: 0.35, 95% CI: 0.13-0.95) was associated with lower frailty levels in the frail group. CONCLUSION It is important to classify older adult patients with cancer into pre-frail and frail groups so that interventions can be provided on time. Understanding the characteristics associated with frailty in older adult patients with cancer can positively affect their health-related quality of life and treatment outcomes.
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Affiliation(s)
- Misun Jeon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyoeun Jang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Arum Lim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sanghee Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Dimitriadis I, Mavroudopoulos I, Kyrama S, Toliopoulos T, Gounaris A, Vakali A, Billis A, Bamidis P. Scalable real-time health data sensing and analysis enabling collaborative care delivery. SOCIAL NETWORK ANALYSIS AND MINING 2022. [DOI: 10.1007/s13278-022-00891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ekramzadeh M, Santoro D, Kopple JD. The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients. Nutrients 2022; 14:nu14102129. [PMID: 35631270 PMCID: PMC9143955 DOI: 10.3390/nu14102129] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with stages 4 and 5 chronic kidney disease (CKD), and particularly chronic dialysis patients, commonly are found to have substantially reduced daily physical activity in comparison to age- and sex-matched normal adults. This reduction in physical activity is associated with a major decrease in physical exercise capacity and physical performance. The CKD patients are often physically deconditioned, and protein energy wasting (PEW) and frailty are commonly present. These disorders are of major concern because physical dysfunction, muscle atrophy, and reduced muscle strength are associated with poor quality of life and increased morbidity and mortality in CKD and chronic dialysis patients. Many randomized controlled clinical trials indicate that when CKD and chronic dialysis are provided nutritional supplements or undergo exercise training their skeletal muscle mass and exercise capacity often increase. It is not known whether the rise in skeletal muscle mass and exercise capacity associated with nutritional support or exercise training will reduce morbidity or mortality rates. A limitation of these clinical trials is that the sample sizes of the different treatment groups were small. The aim of this review is to discuss the effects of nutrition and exercise on body composition, exercise capacity, and physical functioning in advanced CKD patients.
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Affiliation(s)
- Maryam Ekramzadeh
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
- Division of Nephrology and Hypertension, Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, Nephrology and Dialysis, University of Messina, 98100 Messina, Italy;
| | - Joel D. Kopple
- Division of Nephrology and Hypertension, Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- David Geffen School of Medicine, University of California, Los Angeles UCLA, Los Angeles, CA 90095, USA
- Fielding School of Public Health, University of California, Los Angeles UCLA, Los Angeles, CA 90095, USA
- Correspondence: ; Tel.: +1-310-968-5668
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Dong Q, Song N, Qin N, Chen C, Li Z, Sun X, Easton J, Mulder H, Plyler E, Neale G, Walker E, Li Q, Ma X, Chen X, Huang IC, Yasui Y, Ness KK, Zhang J, Hudson MM, Robison LL, Wang Z. Genome-wide association studies identify novel genetic loci for epigenetic age acceleration among survivors of childhood cancer. Genome Med 2022; 14:32. [PMID: 35313970 PMCID: PMC8939156 DOI: 10.1186/s13073-022-01038-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/09/2022] [Indexed: 12/13/2022] Open
Abstract
Background Increased epigenetic age acceleration (EAA) in survivors of childhood cancer is associated with specific treatment exposures, unfavorable health behaviors, and presence of certain chronic health conditions. To better understand inter-individual variability, we investigated the genetic basis underlying EAA. Methods Genome-wide association studies of EAA based on multiple epigenetic clocks (Hannum, Horvath, PhenoAge, and GrimAge) were performed. MethylationEPIC BeadChip array and whole-genome sequencing data were generated with blood-derived DNA from participants in the St. Jude Lifetime Cohort Study (discovery: 2138 pre-existing and 502 newly generated data, all survivors; exploratory: 282 community controls). Linear regression models were fit for each epigenetic age against the allelic dose of each genetic variant, adjusting for age at sampling, sex, and cancer treatment exposures. Fixed-effects meta-analysis was used to combine summary statistics from two discovery data sets. LD (Linkage disequilibrium) score regression was used to estimate single-nucleotide polymorphism (SNP)-based heritability. Results For EAA-Horvath, a genome-wide significant association was mapped to the SELP gene with the strongest SNP rs732314 (meta-GWAS: β=0.57, P=3.30×10-11). Moreover, the stratified analysis of the association between rs732314 and EAA-Horvath showed a substantial heterogeneity between children and adults (meta-GWAS: β=0.97 vs. 0.51, I2=73.1%) as well as between survivors with and without chest/abdominal/pelvic-RT exposure (β=0.64 vs. 0.31, I2=66.3%). For EAA-Hannum, an association was mapped to the HLA locus with the strongest SNP rs28366133 (meta-GWAS: β=0.78, P=3.78×10-11). There was no genome-wide significant hit for EAA-PhenoAge or EAA-GrimAge. Interestingly, among community controls, rs732314 was associated with EAA-Horvath (β=1.09, P=5.43×10-5), whereas rs28366133 was not associated with EAA-Hannum (β=0.21, P=0.49). The estimated heritability was 0.33 (SE=0.20) for EAA-Horvath and 0.17 (SE=0.23) for EAA-Hannum, but close to zero for EAA-PhenoAge and EAA-GrimAge. Conclusions We identified novel genetic variants in the SELP gene and HLA region associated with EAA-Horvath and EAA-Hannum, respectively, among survivors of childhood cancer. The new genetic variants in combination with other replicated known variants can facilitate the identification of survivors at higher risk in developing accelerated aging and potentially inform drug targets for future intervention strategies among vulnerable survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s13073-022-01038-6.
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Affiliation(s)
- Qian Dong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
| | - Nan Song
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA.,College of Pharmacy, Chungbuk National University, Cheongju, Korea
| | - Na Qin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA.,Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Cheng Chen
- School of Public Health, Shanghai Jiaotong University, Shanghai, China
| | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
| | - Xiaojun Sun
- Department of Structural Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - John Easton
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Heather Mulder
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Emily Plyler
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Geoffrey Neale
- Hartwell Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Emily Walker
- Hartwell Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Qian Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Xiaotu Ma
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Xiang Chen
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA. .,Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Chen S, Ma T, Cui W, Li T, Liu D, Chen L, Zhang G, Zhang L, Fu Y. Frailty and long-term survival of patients with colorectal cancer: a meta-analysis. Aging Clin Exp Res 2022; 34:1485-1494. [PMID: 35103954 DOI: 10.1007/s40520-021-02072-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frailty has been related with the risk of postoperative complication in patients with colorectal cancer (CRC). However, the association between frailty and long-term survival in patients with CRC has not been comprehensively evaluated. We performed a meta-analysis to systematically evaluate the relationship between frailty and long-term survival of these patients. METHODS Relevant cohort studies with follow-up duration ≥ 1 year were identified from Medline, Embase, and Web of Science. A random-effect model after incorporation of the between-study heterogeneity was selected to pool the results. RESULTS Ten cohort studies with 35,546 patients were included, and 4100 (11.5%) of them had frailty. Pooled results showed that patients with frailty had worse overall survival compared to those without frailty at baseline (relative risk [RR]: 2.21, 95% confidence interval [CI] 1.43-3.41, P < 0.001; I2 = 92%). Results were consistent for studies adjusting age (RR: 2.20, P < 0.001) or including older cancer patients only (RR: 2.28, P = 0.002). Subgroup analyses showed that difference in study design, follow-up duration, or study quality scores may not significantly affect the findings (P for subgroup analyses all > 0.05). Further meta-analyses with two datasets showed that frailty was also associated with worse cancer-specific survival (RR: 4.60, 95% CI 2.75-7.67, P < 0.001; I2 = 38%) and recurrence-free survival (RR: 1.72, 95% CI 1.30-2.28, P < 0.001; I2 = 0%). CONCLUSIONS Frailty at admission is associated with worse survival of patients with colorectal cancer.
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Affiliation(s)
- Suhua Chen
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China.
| | - Tianjiang Ma
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Wei Cui
- Department of Spinal Surgery, Luohe Central Hospital, Luohe, 462000, China
| | - Taowei Li
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Duoping Liu
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Lang Chen
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Guoyao Zhang
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Lei Zhang
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
| | - Yali Fu
- The Second Department of Oncology, Luohe Central Hospital, No. 54 Renmin East Road, Luohe, 462000, China
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Dociak-Salazar E, Barrueto-Deza JL, Urrunaga-Pastor D, Runzer-Colmenares FM, Parodi JF. Gait speed as a predictor of mortality in older men with cancer: A longitudinal study in Peru. Heliyon 2022; 8:e08862. [PMID: 35146168 PMCID: PMC8816678 DOI: 10.1016/j.heliyon.2022.e08862] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/09/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Given the increase in incidence and mortality from cancer in recent years in Latin America and Peru, it is necessary to identify frailty older adults at higher risk of disability, hospitalizations and mortality. However, its measure is complex and requires time. For this reason, it has been proposed that frailty can be evaluated by a single measure, as gait speed. We aimed to evaluate the role of gait speed as a predictor of mortality in older men with cancer in Peru. Methods A prospective cohort study was carried out that included military veterans (aged 60 years and older) with an oncological diagnosis evaluated at the Centro Médico Naval in Peru during the period 2013–2015. Slow gait speed was defined as <0.8 m/s. All-cause mortality was recorded during a 2-year follow-up. Sociodemographic characteristics, medical and personal history, and functional assessment measures were collected. We performed Cox regression analysis to calculate hazard ratios with their respective 95% confidence intervals. Results 922 older men were analyzed from 2013 to 2015, 56.9% (n = 525) of whom were >70 years of age. 41.3% (n = 381) had slow gait speed with a mortality incidence of 22.9% (n = 211) at the end of follow-up. The most frequent types of cancer in the participants who died were of the lung and airways (26.1%), liver and bile ducts (23.2%), and lymphomas and leukemias (16.6%). In the adjusted Cox regression analysis, we found that slow gait speed was a risk factor for mortality in older men with cancer (adjusted hazard ratio = 1.55; 95% confidence interval: 1.21–2.23). Conclusions Slow gait speed was associated with an increased risk of mortality in older men with cancer. Gait speed could represent a simple, useful, inexpensive, rapidly applicable marker of frailty for the identification of older men at higher risk of mortality. Gait speed could be useful in low- and middle-income countries, and in rural areas with limited access to health services.
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Muzyka M, Tagliafico L, Serafini G, Baiardini I, Braido F, Nencioni A, Monacelli F. Neuropsychiatric Disorders and Frailty in Older Adults over the Spectrum of Cancer: A Narrative Review. Cancers (Basel) 2022; 14:258. [PMID: 35008421 PMCID: PMC8796027 DOI: 10.3390/cancers14010258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The interplay between different neuropsychiatric conditions, beyond dementia, in the presence of a diagnosis of cancer in older adults may mediate patients' fitness and cancer-related outcomes. Here, we aimed to investigate the presence of depression, sleep disturbances, anxiety, attitude, motivation, and support in older adults receiving a diagnosis of cancer and the dimension of frailty in order to understand the magnitude of the problem. METHODS This review provides an update of the state of the art based on references from searches of PubMed between 2000 and June 2021. RESULTS The evidence obtained underscored the tight association between frailty and unfavorable clinical outcomes in older adults with cancer. Given the intrinsic correlation of neuropsychiatric disorders with frailty in the realm of cancer survivorship, the evidence showed they might have a correlation with unfavorable clinical outcomes, late-life geriatric syndromes and higher degree of frailty. CONCLUSIONS The identification of common vulnerabilities among neuropsychiatric disorders, frailty, and cancer may hold promise to unmask similar shared pathways, potentially intercepting targeted new interventions over the spectrum of cancer with the delivery of better pathways of care for older adults with cancer.
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Affiliation(s)
- Mariya Muzyka
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Luca Tagliafico
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Gianluca Serafini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Ilaria Baiardini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
| | - Fulvio Braido
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Alessio Nencioni
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
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Sedrak MS, Kirkland JL, Tchkonia T, Kuchel GA. Accelerated aging in older cancer survivors. J Am Geriatr Soc 2021; 69:3077-3080. [PMID: 34534355 PMCID: PMC8595814 DOI: 10.1111/jgs.17461] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023]
Abstract
This editorial comments on the article by Siddique et al.
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Pluimakers VG, van Santen SS, Fiocco M, Bakker MCE, van der Lelij AJ, van den Heuvel-Eibrink MM, Neggers SJCMM. Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review. Obes Rev 2021; 22:e13312. [PMID: 34258851 PMCID: PMC8596408 DOI: 10.1111/obr.13312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022]
Abstract
Childhood cancer survivors (CCS) are at increased risk to develop metabolic syndrome (MetS), diabetes, and cardiovascular disease. Common criteria underestimate adiposity and possibly underdiagnose MetS, particularly after abdominal radiotherapy. A systematic literature review and meta-analysis on the diagnostic and predictive value of nine newer MetS related biomarkers (adiponectin, leptin, uric acid, hsCRP, TNF-alpha, IL-1, IL-6, apolipoprotein B (apoB), and lipoprotein(a) [lp(a)]) in survivors and adult non-cancer survivors was performed by searching PubMed and Embase. Evidence was summarized with GRADE after risk of bias evaluation (QUADAS-2/QUIPS). Eligible studies on promising biomarkers were pooled. We identified 175 general population and five CCS studies. In the general population, valuable predictive biomarkers are uric acid, adiponectin, hsCRP and apoB (high level of evidence), and leptin (moderate level of evidence). Valuable diagnostic biomarkers are hsCRP, adiponectin, uric acid, and leptin (low, low, moderate, and high level of evidence, respectively). Meta-analysis showed OR for hyperuricemia of 2.94 (age-/sex-adjusted), OR per unit uric acid increase of 1.086 (unadjusted), and AUC for hsCRP of 0.71 (unadjusted). Uric acid, adiponectin, hsCRP, leptin, and apoB can be alternative biomarkers in the screening setting for MetS in survivors, to enhance early identification of those at high risk of subsequent complications.
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Affiliation(s)
| | - Selveta S van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Medical Statistics, Department of Biomedical Data Science, Leiden UMC, Leiden, Netherlands.,Mathematical Institute, Leiden University, Leiden, Netherlands
| | - Marie-Christine E Bakker
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, University Medical Center Utrecht, Netherlands
| | - Aart J van der Lelij
- Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
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