Life's Crucial 9 and its influence on frailty and survival in patients with cancer: Insights from NHANES

Abstract

Introduction: This study aims to examine the effect of Life's Crucial 9 (LC9), a comprehensive health measure, on frailty status and its association with all-cause, cancer-related, and non-cancer-related mortality in patients with cancer.

Materials and methods: A prospective cohort study was conducted with 2466 patients with cancer aged 20 years or older (weighted population: 16,222,181) from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The LC9 score was calculated by averaging the Life's Essential 8 (LE8) and depression scores, which reflect psychological well-being. Multivariable logistic regression models were used to examine the relationship between LC9 and frailty in patients with cancer, while Cox proportional hazards models evaluated the associations between LC9 and all-cause, cancer-specific, and non-cancer mortality.

Results: At baseline, 664 deaths were recorded among the 2466 patients with cancer, including 229 from cancer, 138 from heart disease, and 297 from other causes. Higher LC9 scores were linked to a lower risk of frailty and reduced hazard ratios for all-cause and non-cancer mortality, but not for cancer-specific mortality, compared to those with lower scores. Kaplan-Meier survival curves stratified by LC9 quartiles showed that participants in the highest quartile (Q4) had significantly lower risks of death from all causes (P < 0.001), cancer-specific causes (P = 0.01), and non-cancer causes (P < 0.001).

Discussion: In patients with cancer in the United States, higher LC9 scores were independently associated with reduced risks of frailty, all-cause mortality, and non-cancer-related mortality. This health measure may serve as an effective secondary prevention strategy to mitigate mortality in this population.

Keywords: Cause of death; Life's crucial 9; Life's essential 8; NHANES; Neoplasms.