University of Rochester, Rochester, New York.
University of Pittsburgh, Pittsburgh, Pennsylvania.
J Am Geriatr Soc. 2019 May;67(5):928-936. doi: 10.1111/jgs.15934.
To evaluate relationships between frailty and cognition longitudinally in adults 50 years and older with breast cancer receiving chemotherapy.
Secondary analysis of a prospective longitudinal observational study.
University of Rochester NCI Community Oncology Research Program community oncology clinics.
Patients with breast cancer age 50 and older receiving adjuvant/neoadjuvant chemotherapy (n = 376) and age-matched controls without cancer (n = 234).
Frailty was assessed using a modified frailty score from self-reported assessments (weakness, exhaustion, physical activity, and gait speed). Cognition was assessed by patient report (Functional Assessment of Cancer Therapy-Cognition [FACT-Cog]) and objective measures. Frailty and cognition were measured at three time points (prechemotherapy [A1], postchemotherapy [A2], and 6 months postchemotherapy [A3]; similar time interval for controls). Linear regression models evaluated associations between frailty and cognition adjusting for covariates.
The average age was 59 years (standard deviation = 6.4 y). At baseline, patients with cancer had a higher mean frailty score (1.21 vs .73; P < .001) and lower mean FACT-Cog score (158.4 vs 167.3; P < .001) compared with controls. Objective cognitive measures were not statistically different. Longitudinal decline in FACT-Cog between A1 and A2 (P < .05) and between A1 and A3 (P < .01) was associated with increased frailty score in patients compared with controls. Longitudinal worsening in Controlled Oral Word Association (P < .05) and Trail-Making Test (P < .01) were associated with an increase in frailty between A1 and A2 in patients compared with controls; longitudinal decline in the Delayed Match to Sample test was associated with an increase in frailty between A1 and A3 (P < .05) in patients compared with controls. This finding remained significant for a subset analysis of those aged 65 and older.
In patients with breast cancer aged 50 and older, longitudinal decline in FACT-Cog and objective measures of attention and memory were associated with increased frailty during treatment and up to 6 months posttreatment. Overall, our study suggests cognition and frailty are both important factors to assess in breast cancer patients. J Am Geriatr Soc 67:928-936, 2019.
评估 50 岁及以上接受化疗的乳腺癌成人中，虚弱与认知的纵向关系。
前瞻性纵向观察研究的二次分析。
罗切斯特大学 NCI 社区肿瘤学研究计划社区肿瘤学诊所。
接受辅助/新辅助化疗的年龄在 50 岁及以上的乳腺癌患者（n=376）和年龄匹配的无癌症对照（n=234）。
使用自我报告评估（虚弱、疲惫、体力活动和步态速度）来评估虚弱程度。认知通过患者报告（癌症治疗认知功能评估[FACT-Cog]）和客观测量来评估。在三个时间点（化疗前[A1]、化疗后[A2]和化疗后 6 个月[A3]；对照组类似的时间间隔）测量虚弱和认知。线性回归模型调整协变量后评估虚弱与认知之间的关联。
平均年龄为 59 岁（标准差=6.4 岁）。在基线时，与对照组相比，癌症患者的平均虚弱评分更高（1.21 比.73；P<.001），平均 FACT-Cog 评分更低（158.4 比 167.3；P<.001）。客观认知测量无统计学差异。与对照组相比，FACT-Cog 在 A1 到 A2 之间（P<.05）和 A1 到 A3 之间（P<.01）的纵向下降与患者的虚弱评分增加有关。与对照组相比，在 A1 到 A2 之间，控制口头单词联想测验（P<.05）和连线测验（P<.01）的纵向恶化与虚弱的增加有关；在 A1 到 A3 之间，延迟匹配样本测试的纵向下降与虚弱的增加有关（P<.05）。对于年龄在 65 岁及以上的患者进行亚组分析后，该发现仍然具有统计学意义。
在 50 岁及以上接受化疗的乳腺癌患者中，FACT-Cog 和注意力及记忆的客观测量的纵向下降与治疗期间和治疗后 6 个月内的虚弱增加有关。总的来说，我们的研究表明，认知和虚弱都是评估乳腺癌患者的重要因素。美国老年医学会 67：928-936，2019 年。
