Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer

Arti Hurria, Enrique Soto-Perez-de-Celis, Jacob B. Allred, Harvey Jay Cohen, Anait Arsenyan, Karla Ballman, Jennifer Le-Rademacher, Aminah Jatoi, Julie Filo, Jeanne Mandelblatt, Jacqueline M. Lafky, Gretchen Kimmick, Heidi D. Klepin, Rachel A. Freedman, Harold Burstein, Julie Gralow, Antonio C Wolff, Gustav Magrinat, Myra Barginear, Hyman Muss

Research output: Contribution to journalArticle

Abstract

Objectives: To analyze self-reported changes in physical function in older women with breast cancer receiving adjuvant chemotherapy. Design: Secondary analysis of the Cancer and Leukemia Group B (CALGB) 49907 prospective randomized clinical trial. Setting: CALGB institutions in the United States. Participants: Women aged 65 and older with Stage I to III breast cancer enrolled in CALGB 49907 who had physical function data from before and after receipt of adjuvant chemotherapy (N=256; mean age 71.5, range 65–85). Measurements: Participants were administered the physical function subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire before chemotherapy, at the end of chemotherapy, and 12 months after chemotherapy initiation. Functional decline was defined as a more than 10-point decrease from baseline at each time point. Resilience was defined as return to within 10 points of baseline. Multivariable regression was used to examine pretreatment characteristics associated with physical function changes. Results: Of 42% of participants who had physical function decline from before to the end of chemotherapy, 47% recovered by 12 months (were resilient). Almost one-third experienced functional decline from before chemotherapy to 12 months later. Pretreatment fatigue was a risk factor for functional decline from before to the end of chemotherapy (P=.02). Risk factors for functional decline at 12 months included pretreatment dyspnea (P=.007) and being unmarried (P=.01). Conclusion: Functional decline was common in older women receiving adjuvant chemotherapy for breast cancer in a clinical trial. Although half recovered their physical function, one-third had a clinically meaningful decline at 12 months. Strategies are needed to prevent functional decline in older adults receiving chemotherapy.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - Jan 1 2018

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Adjuvant Chemotherapy
Breast Neoplasms
Drug Therapy
Leukemia
Neoplasms
Dyspnea
Fatigue
Randomized Controlled Trials
Quality of Life
Clinical Trials
Organizations
Research

Keywords

  • breast neoplasms
  • older adults
  • quality of life
  • resilience

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Hurria, A., Soto-Perez-de-Celis, E., Allred, J. B., Cohen, H. J., Arsenyan, A., Ballman, K., ... Muss, H. (Accepted/In press). Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.15493

Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer. / Hurria, Arti; Soto-Perez-de-Celis, Enrique; Allred, Jacob B.; Cohen, Harvey Jay; Arsenyan, Anait; Ballman, Karla; Le-Rademacher, Jennifer; Jatoi, Aminah; Filo, Julie; Mandelblatt, Jeanne; Lafky, Jacqueline M.; Kimmick, Gretchen; Klepin, Heidi D.; Freedman, Rachel A.; Burstein, Harold; Gralow, Julie; Wolff, Antonio C; Magrinat, Gustav; Barginear, Myra; Muss, Hyman.

In: Journal of the American Geriatrics Society, 01.01.2018.

Research output: Contribution to journalArticle

Hurria, A, Soto-Perez-de-Celis, E, Allred, JB, Cohen, HJ, Arsenyan, A, Ballman, K, Le-Rademacher, J, Jatoi, A, Filo, J, Mandelblatt, J, Lafky, JM, Kimmick, G, Klepin, HD, Freedman, RA, Burstein, H, Gralow, J, Wolff, AC, Magrinat, G, Barginear, M & Muss, H 2018, 'Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer', Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.15493
Hurria, Arti ; Soto-Perez-de-Celis, Enrique ; Allred, Jacob B. ; Cohen, Harvey Jay ; Arsenyan, Anait ; Ballman, Karla ; Le-Rademacher, Jennifer ; Jatoi, Aminah ; Filo, Julie ; Mandelblatt, Jeanne ; Lafky, Jacqueline M. ; Kimmick, Gretchen ; Klepin, Heidi D. ; Freedman, Rachel A. ; Burstein, Harold ; Gralow, Julie ; Wolff, Antonio C ; Magrinat, Gustav ; Barginear, Myra ; Muss, Hyman. / Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer. In: Journal of the American Geriatrics Society. 2018.
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abstract = "Objectives: To analyze self-reported changes in physical function in older women with breast cancer receiving adjuvant chemotherapy. Design: Secondary analysis of the Cancer and Leukemia Group B (CALGB) 49907 prospective randomized clinical trial. Setting: CALGB institutions in the United States. Participants: Women aged 65 and older with Stage I to III breast cancer enrolled in CALGB 49907 who had physical function data from before and after receipt of adjuvant chemotherapy (N=256; mean age 71.5, range 65–85). Measurements: Participants were administered the physical function subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire before chemotherapy, at the end of chemotherapy, and 12 months after chemotherapy initiation. Functional decline was defined as a more than 10-point decrease from baseline at each time point. Resilience was defined as return to within 10 points of baseline. Multivariable regression was used to examine pretreatment characteristics associated with physical function changes. Results: Of 42{\%} of participants who had physical function decline from before to the end of chemotherapy, 47{\%} recovered by 12 months (were resilient). Almost one-third experienced functional decline from before chemotherapy to 12 months later. Pretreatment fatigue was a risk factor for functional decline from before to the end of chemotherapy (P=.02). Risk factors for functional decline at 12 months included pretreatment dyspnea (P=.007) and being unmarried (P=.01). Conclusion: Functional decline was common in older women receiving adjuvant chemotherapy for breast cancer in a clinical trial. Although half recovered their physical function, one-third had a clinically meaningful decline at 12 months. Strategies are needed to prevent functional decline in older adults receiving chemotherapy.",
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AU - Hurria, Arti

AU - Soto-Perez-de-Celis, Enrique

AU - Allred, Jacob B.

AU - Cohen, Harvey Jay

AU - Arsenyan, Anait

AU - Ballman, Karla

AU - Le-Rademacher, Jennifer

AU - Jatoi, Aminah

AU - Filo, Julie

AU - Mandelblatt, Jeanne

AU - Lafky, Jacqueline M.

AU - Kimmick, Gretchen

AU - Klepin, Heidi D.

AU - Freedman, Rachel A.

AU - Burstein, Harold

AU - Gralow, Julie

AU - Wolff, Antonio C

AU - Magrinat, Gustav

AU - Barginear, Myra

AU - Muss, Hyman

PY - 2018/1/1

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N2 - Objectives: To analyze self-reported changes in physical function in older women with breast cancer receiving adjuvant chemotherapy. Design: Secondary analysis of the Cancer and Leukemia Group B (CALGB) 49907 prospective randomized clinical trial. Setting: CALGB institutions in the United States. Participants: Women aged 65 and older with Stage I to III breast cancer enrolled in CALGB 49907 who had physical function data from before and after receipt of adjuvant chemotherapy (N=256; mean age 71.5, range 65–85). Measurements: Participants were administered the physical function subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire before chemotherapy, at the end of chemotherapy, and 12 months after chemotherapy initiation. Functional decline was defined as a more than 10-point decrease from baseline at each time point. Resilience was defined as return to within 10 points of baseline. Multivariable regression was used to examine pretreatment characteristics associated with physical function changes. Results: Of 42% of participants who had physical function decline from before to the end of chemotherapy, 47% recovered by 12 months (were resilient). Almost one-third experienced functional decline from before chemotherapy to 12 months later. Pretreatment fatigue was a risk factor for functional decline from before to the end of chemotherapy (P=.02). Risk factors for functional decline at 12 months included pretreatment dyspnea (P=.007) and being unmarried (P=.01). Conclusion: Functional decline was common in older women receiving adjuvant chemotherapy for breast cancer in a clinical trial. Although half recovered their physical function, one-third had a clinically meaningful decline at 12 months. Strategies are needed to prevent functional decline in older adults receiving chemotherapy.

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