Zhou Weijiao, Cho Youmin, Shang Shaomei, Li Yuelin, Seo Jisu, Pu Junlan, Song Rhayun
School of Nursing, Peking University, Beijing, China.
College of Nursing, Chungnam National University, 266 Munhwa-Ro, Jung-Gu, Daejeon, South Korea, 35015.
J Cancer Surviv. 2024 Dec 18. doi: 10.1007/s11764-024-01734-9.
Frailty is a major concern in the aging cancer population. It can progress to severe frailty or death or improve to pre-frail or non-frail states. However, frailty transitions in older cancer survivors are not well understood. This study aimed to explore frailty transitions and associated factors in older cancer survivors.
We analyzed data from the National Health and Aging Trends Study (NHATS) in 2017-2022, focusing on older adults aged ≥ 65 who have been diagnosed with cancer. Frailty was assessed annually using the Fried Frailty Phenotype. Multi-state Markov models were used to explore transitions between frailty states (non-frail, pre-frail, frail, and death) and examine the association with sociodemographic factors, comorbidities, and inflammatory biomarkers (IL-6 and CRP).
Among 1219 survivors, 25.27% were non-frail, 52.34% pre-frail, and 22.40% frail at baseline. Over 5 years, there were 1396 transitions: 950 (68.05%) progressed or deceased, and 446 (31.95%) reversed. Pre-frail individuals transitioned to frailty slightly more than they reversed to non-frailty (0.25 vs. 0.21). Frail individuals were more likely to decease than to reverse (0.30 vs. 0.28). Factors associated with frailty progression included older age, lower education, more comorbidities, and higher IL-6 and CRP levels. Being female and obese were protective against the frailty-to-death transition.
The results showed dynamic frailty transitions in older cancer survivors and identified key sociodemographic and physiological factors.
These findings can guide targeted interventions, highlighting the importance of early identification and tailored approaches to prevent frailty progression in older cancer survivors.
衰弱是老年癌症患者群体中的一个主要问题。它可能会发展为严重衰弱或死亡，也可能改善为衰弱前期或非衰弱状态。然而，老年癌症幸存者的衰弱转变情况尚未得到充分了解。本研究旨在探讨老年癌症幸存者的衰弱转变及相关因素。
我们分析了2017 - 2022年美国国家健康与老龄化趋势研究（NHATS）的数据，重点关注年龄≥65岁且已被诊断患有癌症的老年人。每年使用弗里德衰弱表型评估衰弱情况。多状态马尔可夫模型用于探索衰弱状态（非衰弱、衰弱前期、衰弱和死亡）之间的转变，并检验与社会人口学因素、合并症以及炎症生物标志物（白细胞介素-6和C反应蛋白）的关联。
在1219名幸存者中，基线时25.27%为非衰弱，52.34%为衰弱前期，22.40%为衰弱。在5年期间，共发生1396次转变：950次（68.05%）病情进展或死亡，446次（31.95%）病情逆转。衰弱前期个体转变为衰弱的比例略高于转变回非衰弱的比例（0.25对0.21）。衰弱个体死亡的可能性大于病情逆转的可能性（0.30对0.28）。与衰弱进展相关的因素包括年龄较大、教育程度较低、合并症较多以及白细胞介素-6和C反应蛋白水平较高。女性和肥胖对衰弱到死亡的转变具有保护作用。
结果显示老年癌症幸存者存在动态的衰弱转变，并确定了关键的社会人口学和生理因素。
这些发现可为有针对性的干预措施提供指导，凸显早期识别和量身定制方法对于预防老年癌症幸存者衰弱进展的重要性。
