2817 - Radiation Therapy Is Associated with Prefrailty in Breast Cancer Survivors Aged 40-65

B. Jia¹, C. Wang², J. B. De Vis³, K. Nguyen¹, M. Alford⁴, M. Rafat⁵, X. O. Shu⁴, and A. B. Chakravarthy³; ¹Vanderbilt University School of Medicine, Nashville, TN, ²Vanderbilt University, Nashville, TN, ³Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, ⁴Vanderbilt University Medical Center, Nashville, TN, ⁵Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN

Purpose/Objective(s): Frailty and pre-frailty comprise a multifactorial spectrum of increased vulnerability to cognitive and functional deterioration, disease complications, and comorbidities. Cancer patients are at increased risk for development of pre-frailty and frailty as a result of their disease as well as cancer treatments. Studies have analyzed the effects of chemotherapy on frailty in cancer patients, but the association between frailty and radiation therapy is less well-understood. In this study, we evaluated the effects of radiation treatment on breast cancer survivors’ risk of prefrailty and frailty. Materials/

Methods: Subjects enrolled in this study were breast cancer survivors with localized breast cancer who completed an online questionnaire that included a 56-item survey of functional impairments, limits on physical and mental health, daily living, social health, and prevalence of aging-related disease from which a cumulative deficit index (CDI) was estimated. Participants’ frailty level was classified based on their CDI score as robust (CDI = 0.2), prefrail (0.2 < CDI = 0.35), or frail (CDI > 0.35) status. Corresponding cancer and treatment information was collected from the electronic medical record. Multinomial logistic regression models were used to evaluate the association between radiation treatment and frailty status, with adjustment for age and education, baseline comorbidities, menopausal status, time since diagnosis, cancer stage/subtype, and other treatments received. Stratified analyses were conducted by age at time of survey, 40-65 or = 65 years.
Results: This study enrolled 319 breast cancer patients, all of whom received surgery and 242 of whom were treated with adjuvant radiation. Overall, compared with those who did not receive radiation therapy, those who received radiation therapy had a nonsignificant higher risk of pre-frailty (OR=1.75, 95% CI=0.96, 3.19) and frailty (OR=0.93, 95% CI=0.42, 2.06). Among participants aged 40-65 (N=168), radiation therapy was significantly associated with increased prefrail status (OR=4.94, 95% CI=1.67, 14.59).
Conclusion: Radiation therapy was associated with a higher prevalence of pre-frailty in breast cancer patients aged 40 to 65 independent of systemic treatments. Our study suggests that younger breast cancer patients receiving radiation therapy might benefit from frailty assessment and interventions such as group exercise, nutrient supplementation, and cognitive training that have been shown to delay or even reverse the progression of pre-frailty to frailty.