Functional decline in older breast cancer survivors treated with and without chemotherapy and non-cancer controls: results from the Hurria Older PatiEnts (HOPE) prospective study

Mina S Sedrak; Can-Lan Sun; Marie Bae; Rachel A Freedman; Allison Magnuson; Tracey O'Connor; Beverly Moy; Tanya M Wildes; Heidi D Klepin; Andrew E Chapman; William P Tew; Efrat Dotan; Mary Anne Fenton; Heeyoung Kim; Vani Katheria; Hyman B Muss; Harvey J Cohen; Cary P Gross; Jingran Ji

doi:10.1007/s11764-024-01594-3

Functional decline in older breast cancer survivors treated with and without chemotherapy and non-cancer controls: results from the Hurria Older PatiEnts (HOPE) prospective study

J Cancer Surviv. 2024 Apr 28. doi: 10.1007/s11764-024-01594-3. Online ahead of print.

Authors

Mina S Sedrak^{1

2

3}, Can-Lan Sun^{4

5}, Marie Bae⁶, Rachel A Freedman⁷, Allison Magnuson⁸, Tracey O'Connor⁹, Beverly Moy¹⁰, Tanya M Wildes¹¹, Heidi D Klepin¹², Andrew E Chapman¹³, William P Tew¹⁴, Efrat Dotan¹⁵, Mary Anne Fenton¹⁶, Heeyoung Kim^{4

5}, Vani Katheria^{4

5}, Hyman B Muss¹⁷, Harvey J Cohen¹⁸, Cary P Gross¹⁹, Jingran Ji⁶

Affiliations

¹ Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA. MSedrak@mednet.ucla.edu.
² Cancer & Aging Program, UCLA Health Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA. MSedrak@mednet.ucla.edu.
³ UCLA David Geffen School of Medicine, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA. MSedrak@mednet.ucla.edu.
⁴ Department of Supportive Care, City of Hope, Duarte, CA, USA.
⁵ Center for Cancer and Aging, City of Hope, Duarte, CA, USA.
⁶ Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA.
⁷ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁸ Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
⁹ Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL, USA.
¹⁰ Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹¹ Department of Medicine, Medical Center/Nebraska Medicine, University of Nebraska, Omaha, NE, USA.
¹² Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
¹³ Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA, USA.
¹⁴ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
¹⁵ Department of Hematology-Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
¹⁶ Department of Medicine, Brown University, Providence, RI, USA.
¹⁷ Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
¹⁸ Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹⁹ Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA.

PMID: 38678525
DOI: 10.1007/s11764-024-01594-3

Abstract

Purpose: This study aimed to assess whether physical functional decline in older women with early-stage breast cancer is driven by cancer, chemotherapy, or a combination of both.

Methods: We prospectively sampled three groups of women aged ≥ 65: 444 with early-stage breast cancer receiving chemotherapy (BC Chemo), 98 with early-stage breast cancer not receiving chemotherapy (BC Control), and 100 non-cancer controls (NC Control). Physical function was assessed at two timepoints (T1 [baseline] and T2 [3, 4, or 6 months]) using the Physical Functioning Subscale (PF-10) of the RAND 36-item Short Form. The primary endpoint was the change in PF-10 scores from T1 to T2, analyzed continuously and dichotomously (Yes/No, with "yes" indicating a PF-10 decline > 10 points, i.e., a substantial and clinically meaningful difference).

Results: Baseline PF-10 scores were similar across all groups. The BC Chemo group experienced a significant decline at T2, with a median change in PF-10 of -5 (interquartile range [IQR], -20, 0), while BC Control and NC Control groups showed a median change of 0 (IQR, -5, 5; p < 0.001). Over 30% of BC Chemo participants had a substantial decline in PF-10 vs. 8% in the BC Control and 5% in the NC Control groups (p < 0.001).

Conclusion: In this cohort of older adults with early-stage breast cancer, the combination of breast cancer and chemotherapy contributes to accelerated functional decline. Our findings reinforce the need to develop interventions aimed at preserving physical function, particularly during and after chemotherapy.

Implications for cancer survivors: The high prevalence of accelerated functional decline in older women undergoing breast cancer chemotherapy underscores the urgency to develop interventions aimed at preserving physical function and improving health outcomes.

Clinical trial: NCT01472094, Hurria Older PatiEnts (HOPE) with Breast Cancer Study.

Keywords: Adjuvant Chemotherapy; Breast cancer; Older adults; Physical function.

Abstract

Grants and funding