Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
J Natl Cancer Inst. 2021 Aug 2;113(8):1053-1064. doi: 10.1093/jnci/djab003.
We evaluated deficit accumulation and how deficits affected cognition and physical activity among breast cancer survivors and non-cancer controls.
Newly diagnosed nonmetastatic survivors (n = 353) and matched non-cancer controls (n = 355) ages 60-98 years without neurological impairments were assessed presystemic therapy (or at enrollment for controls) from August 2010 to December 2016 and followed for 36 months. Scores on a 42-item index were analyzed in growth-mixture models to determine deficit accumulation trajectories separately and combined for survivors and controls. Multilevel models tested associations between trajectory and cognition (FACT-Cog and neuropsychological tests) and physical activity (IPAQ-SF) for survivors and controls.
Deficit accumulation scores were in the robust range, but survivors had higher scores (95% confidence intervals [CI]) than controls at 36 months (0.18, 95% CI = 0.16 to 0.19, vs 0.16, 95% CI = 0.14 to 0.17; P = .001), and averages included diverse deficit trajectories. Survivors who were robust but became frailer (8.8%) had similar baseline characteristics to those remaining robust (76.2%) but experienced a 9.6-point decline self-reported cognition (decline of 9.6 vs 3.2 points; P = .04) and a 769 MET minutes per week decline in physical activity (P < .001). Survivors who started and remained prefrail (15.0%) had self-reported and objective cognitive problems. At baseline, frail controls (9.5%) differed from robust controls (83.7%) on deficits and self-reported cognition (P < .001). Within combined trajectories, frail survivors had more sleep disturbances than frail controls (48.6% [SD = 17.4%] vs 25.0% [SD = 8.2%]; P = .05).
Most survivors and controls remained robust, and there were similar proportions on a frail trajectory. However, there were differences in deficit patterns between survivors and controls. Survivor deficit accumulation trajectory was associated with patient-reported outcomes. Additional research is needed to understand how breast cancer and its treatments affect deficit accumulation.
我们评估了乳腺癌幸存者和非癌症对照者的缺陷积累情况，以及缺陷如何影响认知和身体活动。
2010 年 8 月至 2016 年 12 月，对 353 名新诊断的非转移性幸存者（无神经损伤）和 355 名年龄在 60-98 岁之间的匹配非癌症对照者进行了系统治疗前（或对照者入组时）评估，并随访 36 个月。使用生长混合模型对 42 项指数的得分进行分析，以分别确定幸存者和对照组的缺陷积累轨迹，并将其合并。对于幸存者和对照组，多层次模型测试了轨迹与认知（FACT-Cog 和神经心理学测试）和身体活动（IPAQ-SF）之间的关联。
缺陷积累得分处于较高水平，但幸存者在 36 个月时的得分（95%置信区间[CI]）高于对照组（0.18，95%CI=0.16-0.19，vs 0.16，95%CI=0.14-0.17；P=0.001），且平均值包括各种缺陷轨迹。从健壮变为脆弱的幸存者（8.8%）与保持健壮的幸存者（76.2%）具有相似的基线特征，但认知自我报告下降了 9.6 点（下降 9.6 与 3.2 点；P=0.04），身体活动每周减少了 769 个梅脱分钟（P<.001）。从开始到一直处于虚弱状态的幸存者（15.0%）存在认知问题。在基线时，虚弱的对照组（9.5%）与健壮的对照组（83.7%）在缺陷和自我报告认知方面存在差异（P<.001）。在综合轨迹内，虚弱的幸存者比虚弱的对照组有更多的睡眠障碍（48.6%[SD=17.4%]与 25.0%[SD=8.2%]；P=0.05）。
大多数幸存者和对照组保持健壮，脆弱轨迹的比例相似。然而，幸存者和对照组之间的缺陷模式存在差异。幸存者的缺陷积累轨迹与患者报告的结果相关。需要进一步研究来了解乳腺癌及其治疗如何影响缺陷积累。
