Toxicity risk score and clinical decline after adjuvant chemotherapy in older breast cancer survivors.
Journal
Journal of the National Cancer Institute
ISSN: 1460-2105
Titre abrégé: J Natl Cancer Inst
Pays: United States
ID NLM: 7503089
Informations de publication
Date de publication:
08 05 2023
08 05 2023
Historique:
received:
20
10
2022
revised:
01
01
2023
accepted:
28
01
2023
pmc-release:
10
02
2024
medline:
9
5
2023
pubmed:
11
2
2023
entrez:
10
2
2023
Statut:
ppublish
Résumé
Chemotoxicity risk scores were developed to predict grade 3-5 chemotherapy toxicity in older women with early breast cancer. However, whether these toxicity risk scores are associated with clinically meaningful decline in patient health remains unknown. In a prospective study of women aged 65 years and older with stage I-III breast cancer treated with chemotherapy, we assessed chemotoxicity risk using the Cancer and Aging Research Group-Breast Cancer (CARG-BC) score (categorized as low, intermediate, and high). We measured patient health status before (T1) and after (T2) chemotherapy using a clinical frailty index (Deficit Accumulation Index, categorized as robust, prefrail, and frail). The population of interest was robust women at T1. The primary outcome was decline in health status after chemotherapy, defined as a decline in Deficit Accumulation Index from robust at T1 to prefrail or frail at T2. Multivariable logistic regression was used to examine the association between T1 CARG-BC score and decline in health status, adjusted for sociodemographic and clinical characteristics. Of the 348 robust women at T1, 83 (24%) experienced declining health status after chemotherapy, of whom 63% had intermediate or high CARG-BC scores. After adjusting for sociodemographic and clinical characteristics, women with intermediate (odds ratio = 3.14, 95% confidence interval = 1.60 to 6.14, P < .001) or high (odds ratio = 3.80, 95% confidence interval = 1.35 to 10.67, P = .01) CARG-BC scores had greater odds of decline in health status compared with women with low scores. In this cohort of older women with early breast cancer, higher CARG-BC scores before chemotherapy were associated with decline in health status after chemotherapy independent of sociodemographic and clinical risk factors.
Sections du résumé
BACKGROUND
Chemotoxicity risk scores were developed to predict grade 3-5 chemotherapy toxicity in older women with early breast cancer. However, whether these toxicity risk scores are associated with clinically meaningful decline in patient health remains unknown.
METHODS
In a prospective study of women aged 65 years and older with stage I-III breast cancer treated with chemotherapy, we assessed chemotoxicity risk using the Cancer and Aging Research Group-Breast Cancer (CARG-BC) score (categorized as low, intermediate, and high). We measured patient health status before (T1) and after (T2) chemotherapy using a clinical frailty index (Deficit Accumulation Index, categorized as robust, prefrail, and frail). The population of interest was robust women at T1. The primary outcome was decline in health status after chemotherapy, defined as a decline in Deficit Accumulation Index from robust at T1 to prefrail or frail at T2. Multivariable logistic regression was used to examine the association between T1 CARG-BC score and decline in health status, adjusted for sociodemographic and clinical characteristics.
RESULTS
Of the 348 robust women at T1, 83 (24%) experienced declining health status after chemotherapy, of whom 63% had intermediate or high CARG-BC scores. After adjusting for sociodemographic and clinical characteristics, women with intermediate (odds ratio = 3.14, 95% confidence interval = 1.60 to 6.14, P < .001) or high (odds ratio = 3.80, 95% confidence interval = 1.35 to 10.67, P = .01) CARG-BC scores had greater odds of decline in health status compared with women with low scores.
CONCLUSIONS
In this cohort of older women with early breast cancer, higher CARG-BC scores before chemotherapy were associated with decline in health status after chemotherapy independent of sociodemographic and clinical risk factors.
Identifiants
pubmed: 36762832
pii: 7034108
doi: 10.1093/jnci/djad029
pmc: PMC10165485
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
578-585Subventions
Organisme : NIA NIH HHS
ID : K76 AG074918
Pays : United States
Organisme : NIA NIH HHS
ID : R03 AG064377
Pays : United States
Organisme : NCI NIH HHS
ID : R21 CA277660
Pays : United States
Organisme : NIA NIH HHS
ID : NIA R01 AG037037
Pays : United States
Organisme : NCI NIH HHS
ID : K12CA001727
Pays : United States
Organisme : NIA NIH HHS
ID : K76AG074918
Pays : United States
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Références
J Am Geriatr Soc. 2006 Jun;54(6):975-9
pubmed: 16776795
Nat Aging. 2021 Aug;1(8):651-665
pubmed: 37117769
J Natl Cancer Inst. 2019 Dec 1;111(12):1245-1254
pubmed: 31321426
J Clin Oncol. 2018 Aug 1;36(22):2326-2347
pubmed: 29782209
JAMA Netw Open. 2021 Feb 1;4(2):e2036695
pubmed: 33587134
J Clin Oncol. 2016 Sep 10;34(26):3157-65
pubmed: 27458291
J Natl Compr Canc Netw. 2018 Jun;16(6):703-710
pubmed: 29891521
J Clin Oncol. 2011 Dec 10;29(35):4647-53
pubmed: 22067407
J Geriatr Oncol. 2021 May;12(4):658-665
pubmed: 33172805
JAMA. 2005 Mar 2;293(9):1073-81
pubmed: 15741529
J Geriatr Oncol. 2016 Jul;7(4):249-57
pubmed: 26725537
Breast Cancer Res Treat. 2017 Jul;164(1):107-117
pubmed: 28364214
Health Rep. 2013 Sep;24(9):10-7
pubmed: 24258362
J Cancer Surviv. 2013 Mar;7(1):20-31
pubmed: 23232922
J Am Geriatr Soc. 2018 Aug;66(8):1451-1454
pubmed: 30094816
J Clin Oncol. 2021 Jul 1;39(19):2079-2089
pubmed: 34043454
J Am Geriatr Soc. 2019 May;67(5):920-927
pubmed: 30146695
J Oncol Pract. 2014 Sep;10(5):e285-92
pubmed: 25074878
J Clin Oncol. 2007 Aug 20;25(24):3699-704
pubmed: 17704418
J Clin Oncol. 2021 Feb 20;39(6):608-618
pubmed: 33444080
Clin Cancer Res. 2009 Aug 1;15(15):4806-14
pubmed: 19622575
J Gerontol A Biol Sci Med Sci. 2019 Jul 12;74(8):1271-1276
pubmed: 30165612
J Natl Cancer Inst. 2021 Aug 2;113(8):1053-1064
pubmed: 33484565
J Natl Compr Canc Netw. 2017 Jul;15(7):894-902
pubmed: 28687577
N Engl J Med. 2009 May 14;360(20):2055-65
pubmed: 19439741
ScientificWorldJournal. 2001 Aug 08;1:323-36
pubmed: 12806071
Cancer. 2020 Apr 15;126(8):1708-1716
pubmed: 31977084
J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):722-7
pubmed: 17634318
Cancer. 2018 May 15;124(10):2184-2191
pubmed: 29499074
J Clin Oncol. 2012 May 1;30(13):1447-55
pubmed: 22454424
J Clin Oncol. 2014 Aug 1;32(22):2318-27
pubmed: 24934786
Cancer. 2016 Dec 15;122(24):3865-3872
pubmed: 27529755
J Clin Oncol. 2021 Jul 1;39(19):2068-2078
pubmed: 34043430
Cancer. 2012 Jul 1;118(13):3377-86
pubmed: 22072065
J Am Geriatr Soc. 2009 Sep;57(9):1532-9
pubmed: 19682112
Mech Ageing Dev. 2019 Jun;180:107-116
pubmed: 31002924
J Am Geriatr Soc. 2010 Apr;58(4):681-7
pubmed: 20345864
J Gerontol A Biol Sci Med Sci. 2020 May 22;75(6):1143-1147
pubmed: 32145016
J Clin Oncol. 2023 Jan 10;41(2):316-326
pubmed: 36455189
JAMA Oncol. 2017 Dec 1;3(12):e172319
pubmed: 28796857
J Clin Oncol. 2011 Sep 1;29(25):3457-65
pubmed: 21810685
J Clin Oncol. 2014 Jul 1;32(19):2010-7
pubmed: 24868022
BMC Geriatr. 2008 Sep 30;8:24
pubmed: 18826625
J Clin Oncol. 2023 Jan 10;41(2):307-315
pubmed: 36126235
J Am Med Dir Assoc. 2015 Oct 1;16(10):842-7
pubmed: 25952475
J Clin Oncol. 2006 Jun 20;24(18):2750-6
pubmed: 16782915
J Am Geriatr Soc. 2008 May;56(5):898-903
pubmed: 18363679
J Natl Cancer Inst. 2019 Aug 1;111(8):837-844
pubmed: 30951603
N Engl J Med. 2002 Apr 4;346(14):1061-6
pubmed: 11932474