Abstract PO2-12-02: Frailty among long-term breast cancer survivors
Authors: Wang Cong , De Vis Jill , Nguyen Kirsten , Alford Mason , Jia Brigitte , Chakravarthy Bapsi , Shu Xiao-Ou 
Published: May 2024

Abstract
Background Cancer and its associated treatments may accelerate aging, resulting in increased frailty in survivors. However, the effect of breast cancer (BC) and treatment on frailty among long-term BC survivors has not been well investigated. This study aims to evaluate frailty prevalence and its association with clinical characteristics and treatment among 5-year BC survivors. Methods This study included 353 5-year BC survivors and 214 non-cancer control women aged ≥40 who were recruited to an ongoing breast health study at Vanderbilt University Medical Center between 2004 and 2017, and completed an online survey between May, 2022 and June 2023. Information collected includes demographics, lifestyle, disease history, and current health/functional status. A 26-item cumulative deficit index (CDI) was calculated as the proportion of deficits presented, including aging-related diseases, physical and mental health, activities of daily living, and social well-being, based on survey responses. CDI was categorized as robust (≤0.2), pre-frail (0.2-≤0.35), and frail ( &gt;0.35). Cancer characteristics and treatment information was gathered from tumor registry. Multinomial logistic regression models were used to assess the association of CDI levels with case-control status, and BC clinical characteristics and cancer treatment among BC cases, with adjustment for age at survey (years), follow-up duration (5-≤10 and &gt;10 years), and baseline Charlson comorbidity index (0, 1, and ≥2), and additional adjustment for BC stage and subtype in the analysis of treatment. Results The median time interval from BC diagnosis to survey was 12 years (range 5-34 years) for BC survivors. 90% of the participants were White. On average, BC patients were 3.8 years older at survey than controls [mean±SD (range) 64.5±9.2 (40-88) vs 60.7±10.3 (40-87), p&lt; 0.001]. Among BC survivors, 41% had stage I, 39% stage II, and 8% stage III-IV cancer; 62% had a hormone receptor+/HER2- BC, followed by 22% HER2+ and 16% triple-negative BC. The majority of BC survivors underwent surgical resection (97%), and &gt;50% received hormone therapy (59%), radiation therapy (53%), and chemotherapy (51%). BC survivors had a higher CDI score than controls (median 0.23 vs 0.19, p=0.01), with 34% and 18% of BC survivors being pre-frail and frail, compared with 25% and 16% in controls. After multivariable adjustment, BC survivors had a non-significantly increased prevalence of pre-frailty with odds ratio (OR) and 95% confidence interval (CI) of 1.49 (0.98-2.25), but a similar prevalence of frailty [OR (95% CI) = 1.08 (0.65-1.79)] compared to controls. BC survivors aged 40-65 had significantly elevated odds of pre-frailty [OR (95% CI) = 2.59 (1.44-4.63)]. Among BC survivors, frailty was significantly associated with stage [stage III-IV vs I: OR (95% CI) = 4.03 (1.27-12.78)] and chemotherapy [OR (95% CI) = 4.39 (1.71-11.30)], particularly among survivors aged ≥65 and 10-year survivors, but not BC subtype. Radiation therapy was associated with increased odds of pre-frailty among BC survivors aged 40-65. Conclusions This study suggests that long-term BC survivors younger than 65 are at increased odds of pre-frailty than non-cancer women. Frailty is associated with BC stage and chemotherapy among BC survivors, and radiotherapy among survivors younger than 65. More research is needed to investigate whether specific cancer treatment regimen is associated with frailty and other factors (e.g. lifestyle and genetics) that may modify the risk of frailty.
The associations of frailty with cancer characteristics and treatments among breast cancer survivors

Citation Format: Cong Wang, Jill De Vis, Kirsten Nguyen, Mason Alford, Brigitte Jia, Bapsi Chakravarthy, Xiao-Ou Shu. Frailty among long-term breast cancer survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-02.