Longitudinal Relationship Between Frailty and Cognition in Patients 50 Years and Older with Breast Cancer

Abstract

Objectives: To evaluate relationships between frailty and cognition longitudinally in adults 50 years and older with breast cancer receiving chemotherapy.

Design: Secondary analysis of a prospective longitudinal observational study.

Setting: University of Rochester NCI Community Oncology Research Program community oncology clinics.

Participants: Patients with breast cancer age 50 and older receiving adjuvant/neoadjuvant chemotherapy (n = 376) and age-matched controls without cancer (n = 234).

Measurements: 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.

Results: 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.

Conclusion: 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.

Trial registration: ClinicalTrials.gov NCT00024102.

Keywords: breast cancer; chemotherapy; cognition; cognitive impairment; frailty.

Figure 1:. Pre- and post- treatment data for (a) frailty, (b) Functional Assessment of Cancer Therapy-Cognition (FACT-Cog) total score, (c) the Controlled Oral Word Association (COWA) test, (d) the Trail Making Test (TMT) A scores, and (e) Delayed Match to Sample (DMS) at the 12-second delay and (f) Rapid Visual Processing (RVP) in breast cancer patients (dark gray) age ≥50 years versus age-matched non-cancer controls (light gray).

The data points show the unadjusted mean and the 95% confidence interval. A1: pre-chemotherapy, A2: post-chemotherapy, A3: six months post-chemotherapy. Lower scores indicate lower performance on FACT-Cog, COWA, DMS, and RVP. Higher scores indicate lower performance on the Frailty Score and TMT.

Figure 2:. Follow-up frailty scores in subjects with greater than versus less than median baseline FACT-Cog score.

The values show the mean frailty score based on FACT-Cog above or below the median at each timepoint. Please note that a lower score on the FACT-Cog indicates worse perceived cognitive abilities.