Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer

A report from the st jude lifetime cohort study

Kirsten K. Ness, Kevin R. Krull, Kendra E. Jones, Daniel A. Mulrooney, Gregory Armstrong, Daniel M. Green, Wassim Chemaitilly, Webb Smith, Carmen L. Wilson, Charles A. Sklar, Kyla Shelton, Deo Kumar Srivastava, Sabeen Ali, Leslie L. Robison, Melissa M. Hudson

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Abstract

Purpose Frailty, a phenotype reported among 9.9% of individuals 65 years old and older (9.6% of women; 5.2% of men), has not been assessed among adult childhood cancer survivors (CCS). We estimated the prevalence of frailty and examined associations with morbidity and mortality. Methods Participants included 1,922 CCS at least 10 years from original cancer diagnosis (men, 50.3%; mean age, 33.6 ± 8.1 years) and a comparison population of 341 participants without cancer histories. Prefrailty and frailty were defined as two and > three 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 for Adverse Events version 4.0). Fisher's exact tests were used to compare, by frailty status, percentages of those with morbidity. In a subset of 162 CCS who returned for a second visit, Poisson regression was used to evaluate associations between frailty and new onset morbidity. Cox proportional hazards regression was used to evaluate associations between frailty and death. Results The prevalence of prefrailty and frailty were 31.5% and 13.1% among women and 12.9% and 2.7% among men, respectively, with prevalence increasing with age. Frail CCS were more likely than nonfrail survivors to have a chronic condition (82.1% v 73.8%). In models adjusted for existing chronic conditions, baseline frailty was associated with risk of death (hazard ratio, 2.6; 95% CI, 1.2 to 6.2) and chronic condition onset (relative risk, 2.2; 95% CI, 1.2 to 4.2). Conclusion The prevalence of frailty among young adult CCS is similar to that among adults 65 years old and older, suggesting accelerated aging.

Original languageEnglish (US)
Pages (from-to)4496-4503
Number of pages8
JournalJournal of Clinical Oncology
Volume31
Issue number36
DOIs
StatePublished - Dec 30 2013

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Survivors
Cohort Studies
Neoplasms
Morbidity
Terminology
Energy Metabolism
Young Adult
Phenotype
Muscles
Mortality
Population

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer : A report from the st jude lifetime cohort study. / Ness, Kirsten K.; Krull, Kevin R.; Jones, Kendra E.; Mulrooney, Daniel A.; Armstrong, Gregory; Green, Daniel M.; Chemaitilly, Wassim; Smith, Webb; Wilson, Carmen L.; Sklar, Charles A.; Shelton, Kyla; Srivastava, Deo Kumar; Ali, Sabeen; Robison, Leslie L.; Hudson, Melissa M.

In: Journal of Clinical Oncology, Vol. 31, No. 36, 30.12.2013, p. 4496-4503.

Research output: Contribution to journalArticle

Ness, KK, Krull, KR, Jones, KE, Mulrooney, DA, Armstrong, G, Green, DM, Chemaitilly, W, Smith, W, Wilson, CL, Sklar, CA, Shelton, K, Srivastava, DK, Ali, S, Robison, LL & Hudson, MM 2013, 'Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer: A report from the st jude lifetime cohort study', Journal of Clinical Oncology, vol. 31, no. 36, pp. 4496-4503. https://doi.org/10.1200/JCO.2013.52.2268
Ness, Kirsten K. ; Krull, Kevin R. ; Jones, Kendra E. ; Mulrooney, Daniel A. ; Armstrong, Gregory ; Green, Daniel M. ; Chemaitilly, Wassim ; Smith, Webb ; Wilson, Carmen L. ; Sklar, Charles A. ; Shelton, Kyla ; Srivastava, Deo Kumar ; Ali, Sabeen ; Robison, Leslie L. ; Hudson, Melissa M. / Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer : A report from the st jude lifetime cohort study. In: Journal of Clinical Oncology. 2013 ; Vol. 31, No. 36. pp. 4496-4503.
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title = "Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer: A report from the st jude lifetime cohort study",
abstract = "Purpose Frailty, a phenotype reported among 9.9{\%} of individuals 65 years old and older (9.6{\%} of women; 5.2{\%} of men), has not been assessed among adult childhood cancer survivors (CCS). We estimated the prevalence of frailty and examined associations with morbidity and mortality. Methods Participants included 1,922 CCS at least 10 years from original cancer diagnosis (men, 50.3{\%}; mean age, 33.6 ± 8.1 years) and a comparison population of 341 participants without cancer histories. Prefrailty and frailty were defined as two and > three 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 for Adverse Events version 4.0). Fisher's exact tests were used to compare, by frailty status, percentages of those with morbidity. In a subset of 162 CCS who returned for a second visit, Poisson regression was used to evaluate associations between frailty and new onset morbidity. Cox proportional hazards regression was used to evaluate associations between frailty and death. Results The prevalence of prefrailty and frailty were 31.5{\%} and 13.1{\%} among women and 12.9{\%} and 2.7{\%} among men, respectively, with prevalence increasing with age. Frail CCS were more likely than nonfrail survivors to have a chronic condition (82.1{\%} v 73.8{\%}). In models adjusted for existing chronic conditions, baseline frailty was associated with risk of death (hazard ratio, 2.6; 95{\%} CI, 1.2 to 6.2) and chronic condition onset (relative risk, 2.2; 95{\%} CI, 1.2 to 4.2). Conclusion The prevalence of frailty among young adult CCS is similar to that among adults 65 years old and older, suggesting accelerated aging.",
author = "Ness, {Kirsten K.} and Krull, {Kevin R.} and Jones, {Kendra E.} and Mulrooney, {Daniel A.} and Gregory Armstrong and Green, {Daniel M.} and Wassim Chemaitilly and Webb Smith and Wilson, {Carmen L.} and Sklar, {Charles A.} and Kyla Shelton and Srivastava, {Deo Kumar} and Sabeen Ali and Robison, {Leslie L.} and Hudson, {Melissa M.}",
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T1 - Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer

T2 - A report from the st jude lifetime cohort study

AU - Ness, Kirsten K.

AU - Krull, Kevin R.

AU - Jones, Kendra E.

AU - Mulrooney, Daniel A.

AU - Armstrong, Gregory

AU - Green, Daniel M.

AU - Chemaitilly, Wassim

AU - Smith, Webb

AU - Wilson, Carmen L.

AU - Sklar, Charles A.

AU - Shelton, Kyla

AU - Srivastava, Deo Kumar

AU - Ali, Sabeen

AU - Robison, Leslie L.

AU - Hudson, Melissa M.

PY - 2013/12/30

Y1 - 2013/12/30

N2 - Purpose Frailty, a phenotype reported among 9.9% of individuals 65 years old and older (9.6% of women; 5.2% of men), has not been assessed among adult childhood cancer survivors (CCS). We estimated the prevalence of frailty and examined associations with morbidity and mortality. Methods Participants included 1,922 CCS at least 10 years from original cancer diagnosis (men, 50.3%; mean age, 33.6 ± 8.1 years) and a comparison population of 341 participants without cancer histories. Prefrailty and frailty were defined as two and > three 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 for Adverse Events version 4.0). Fisher's exact tests were used to compare, by frailty status, percentages of those with morbidity. In a subset of 162 CCS who returned for a second visit, Poisson regression was used to evaluate associations between frailty and new onset morbidity. Cox proportional hazards regression was used to evaluate associations between frailty and death. Results The prevalence of prefrailty and frailty were 31.5% and 13.1% among women and 12.9% and 2.7% among men, respectively, with prevalence increasing with age. Frail CCS were more likely than nonfrail survivors to have a chronic condition (82.1% v 73.8%). In models adjusted for existing chronic conditions, baseline frailty was associated with risk of death (hazard ratio, 2.6; 95% CI, 1.2 to 6.2) and chronic condition onset (relative risk, 2.2; 95% CI, 1.2 to 4.2). Conclusion The prevalence of frailty among young adult CCS is similar to that among adults 65 years old and older, suggesting accelerated aging.

AB - Purpose Frailty, a phenotype reported among 9.9% of individuals 65 years old and older (9.6% of women; 5.2% of men), has not been assessed among adult childhood cancer survivors (CCS). We estimated the prevalence of frailty and examined associations with morbidity and mortality. Methods Participants included 1,922 CCS at least 10 years from original cancer diagnosis (men, 50.3%; mean age, 33.6 ± 8.1 years) and a comparison population of 341 participants without cancer histories. Prefrailty and frailty were defined as two and > three 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 for Adverse Events version 4.0). Fisher's exact tests were used to compare, by frailty status, percentages of those with morbidity. In a subset of 162 CCS who returned for a second visit, Poisson regression was used to evaluate associations between frailty and new onset morbidity. Cox proportional hazards regression was used to evaluate associations between frailty and death. Results The prevalence of prefrailty and frailty were 31.5% and 13.1% among women and 12.9% and 2.7% among men, respectively, with prevalence increasing with age. Frail CCS were more likely than nonfrail survivors to have a chronic condition (82.1% v 73.8%). In models adjusted for existing chronic conditions, baseline frailty was associated with risk of death (hazard ratio, 2.6; 95% CI, 1.2 to 6.2) and chronic condition onset (relative risk, 2.2; 95% CI, 1.2 to 4.2). Conclusion The prevalence of frailty among young adult CCS is similar to that among adults 65 years old and older, suggesting accelerated aging.

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