Increased frailty associated with childhood cancer survivorship

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1. The prevalence of frailty among young adult childhood cancer survivors (CCS) is similar to that in adults 65 years old and older without cancer history.

2. CCS may face accelerated aging, with increased risk of death and chronic conditions. 

Evidence rating level:  2 (Good)

Study Rundown: Given the many advances in the treatment of childhood cancer over the last few decades, the long-term health risks childhood cancer survivors (CCS) face are becoming increasingly important. Previous studies have found that CCS face chronic health conditions and increased hospitalizations and mortality relative to their peers. Furthermore, many report symptoms that interfere with daily life, suggest premature aging. The purpose of this study was to test whether frailty, an indicator of early aging and a predictor of mortality, would be more prevalent among CCS and whether it can predict subsequent poor health.

The authors found that the prefrailty and frailty phenotypes had very high prevalence among CCS compared to values for peers without cancer history in the literature. Their prevalence among young adult CCS was similar to that among adults 65 years old who had not had childhood cancer (9.6% of women, 5.2% of men). Baseline frailty was also associated with an increased risk of death and of chronic condition onset. Based on these findings, the authors concluded that CCS may experience accelerated aging.

This study benefits from its cohort design and large number of enrollees. However, it should be noted that this was a retrospective study, and prospective assessments earlier in survivorship will be necessary to better elucidate the relationship between frailty and risk for chronic conditions and death. Furthermore, as no matching was done between the CCS and control groups, no direct comparison was done due to concerns of confounding. Volunteer bias regarding the CCS who agreed to participate should also be considered. Nevertheless, this study helps to confirm that CCS may have additional health needs compared to others in their age group, and so present a more complex issue for patient care.

Click to read the article in JCO

Relevant reading: Deficits in physical function among young childhood cancer survivors

In-Depth [retrospective cohort study]: The authors of this study recruited a total of 1922 members of the St. Jude Lifetime cohort, all of whom are at least 10 years from original cancer diagnosis (mean age 33 years old). The comparison group of 341 members was drawn from family and friends of patients being treated at St. Jude Children’s research hospital. The primary outcomes measured were the pre-frailty and frailty phenotypes, which were defined as two and three or greater of the following conditions: low muscle mass, self-reported exhaustion, low energy expenditure, slow walking speed, and weakness. Morbidity was defined as grade 3 to 4 chronic conditions (Common Terminology Criteria).

The prevalence of prefrailty and frailty were 31.5% and 13.1% among women and 12.9 and 2.7% among men. Frail CCS were more likely than non-frail survivors to have a chronic condition (82.1% vs 73.8%). After adjusting for chronic conditions, baseline frailty was associated with risk of death (hazard ratio, 2.6; 95% CI, 1.2-6.2) and chronic condition onset (relative risk 2.2, 95% 1.2 to 4.2).

By Monica Parks and Andrew Bishara

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