Frail young adult cancer survivors experience poor health-related quality of life

Abstract

Background: Young adult cancer survivors experience frailty and decreased muscle mass at rates equivalent to much older noncancer populations, which indicate accelerated aging. Although frailty and low muscle mass can be identified in survivors, their implications for health-related quality of life are not well understood.

Methods: Through a cross-sectional analysis of young adult cancer survivors, frailty was assessed with the Fried frailty phenotype and skeletal muscle mass in relation to functional and quality of life outcomes measured by the Medical Outcomes Survey Short-Form 36 (SF-36). z tests compared survivors with US population means, and multivariable linear regression models estimated mean SF-36 scores by frailty and muscle mass with adjustments made for comorbidities, sex, and time from treatment.

Results: Sixty survivors (median age, 21 years; range, 18-29) participated in the study. Twenty-five (42%) had low muscle mass, and 25 were either frail or prefrail. Compared with US population means, survivors reported worse health and functional impairments across SF-36 domains that were more common among survivors with (pre)frailty or low muscle mass. In multivariable linear modeling, (pre)frail survivors (vs nonfrail) exhibited lower mean scores for general health (-9.1; P = .05), physical function (-14.9; P < .01), and overall physical health (-5.6; P = .02) independent of comorbid conditions.

Conclusions: Measures of frailty and skeletal muscle mass identify subgroups of young adult cancer survivors with significantly impaired health, functional status, and quality of life independent of medical comorbidities. Identifying survivors with frailty or low muscle mass may provide opportunities for interventions to prevent functional and health declines or to reverse this process.

Lay summary: Young adult cancer survivors age more quickly than peers without cancer, which is evidenced by a syndrome of decreased resilience known as frailty. The relationship between frailty (and one of its common components, decreased muscle mass) and quality of life among young adult cancer survivors was examined. Measuring decreased muscle mass and frailty identifies young survivors with poor quality of life, including worse general health, fatigue, physical function, and overall physical health, compared with nonfrail survivors. Interventions to address components of frailty (low muscle mass and weakness) may improve function and quality of life among young adult cancer survivors.

Keywords: adolescents; cancer survivorship; frailty; health-related quality of life; muscle mass; young adults.

Figure 1:

Reported quality of life among AYA survivors as compared to the general U.S. population by SF-36 domains. 1A: Comparison of full study cohort of survivors versus general population means. 1B and 1C: Survivors stratified by muscle mass and frailty status. Phys Hlth: physical health, Emo Hlth: emotional health, PH: physical health, MH: mental health

Figure 1:

Reported quality of life among AYA survivors as compared to the general U.S. population by SF-36 domains. 1A: Comparison of full study cohort of survivors versus general population means. 1B and 1C: Survivors stratified by muscle mass and frailty status. Phys Hlth: physical health, Emo Hlth: emotional health, PH: physical health, MH: mental health

Figure 2:

Reported quality of life among AYA survivors as compared to a young adult (24–35yrs) U.S. population by SF-36 domains. 2A: Comparison of full study cohort of survivors versus general population means. 2B and 2C: Survivors stratified by muscle mass and frailty status. Phys Hlth: physical health, Emo Hlth: emotional health, PH: physical health, MH: mental health

Figure 2:

Reported quality of life among AYA survivors as compared to a young adult (24–35yrs) U.S. population by SF-36 domains. 2A: Comparison of full study cohort of survivors versus general population means. 2B and 2C: Survivors stratified by muscle mass and frailty status. Phys Hlth: physical health, Emo Hlth: emotional health, PH: physical health, MH: mental health