Frailty associated with neurocognitive decline among young-adult cancer survivors
Treatment-associated frailty appeared associated with neurocognitive declines among a cohort of young-adult cancer survivors, according to study findings from the St. Jude Lifetime Cohort published in Journal of Clinical Oncology.
“Survivors of childhood and adolescent cancer have high rates of frailty, a physiologic phenotype associated with aging and poor health. In the elderly general population, frailty is associated with neurocognitive decline, dementia and Alzheimer’s disease,” AnnaLynn Williams, PhD, postdoctoral research scholar at St. Jude Children’s Research Hospital, told Healio. “Given the relatively high frequency of neurocognitive impairments in long-term survivors, we wanted to understand if frailty was a risk factor for neurocognitive decline in this population, as well.”
Williams and colleagues evaluated 845 young adult cancer survivors (mean age, 30 years) for treatment-associated prefrailty (18%) or frailty (6%). The survivors, who were at least 10 years from diagnosis (average, 22 years), completed neuropsychologic assessments at baseline between January 2008 and June 2013 and at 5-year follow-up.
Researchers used weighted linear regression with inverse of sampling probability estimates to compare differences in neurocognitive decline among prefrail and frail survivors vs. nonfrail survivors.
After adjusting for diagnosis age, sex, race, central nervous system-directed therapy and baseline neurocognitive performance, results showed frail survivors experienced an average decline in short-term verbal recall of 0.54 (95% CI, 0.93 to 0.15) standard deviation (SD) compared with no decline among nonfrail survivors (B = 0.22; difference of B = 0.76; 95% CI, 1.19 to 0.33).
Frail survivors also experienced greater decreases in visual-motor processing speed (B = 0.4; 95% CI, 0.67 to 0.12), cognitive flexibility (B = 0.62; 95% CI, 1.02- to 0.22) and verbal fluency (B = 0.23; 95% CI, 0.41 to 0.05) than nonfrail survivors.
Moreover, researchers observed greater decreases in focused attention among both prefrail (B = 0.35; 95% CI, 0.53 to 0.17) and frail (B = 0.48; 95% CI, 0.83 to 0.12) vs. nonfrail survivors.
“These data provide further support for the impact of physiologic and functional impairments among childhood and adolescent cancer survivors and highlight the need for broad interventions designed to simultaneously improve physical and cognitive function,” Williams said. “[Although] studies have demonstrated associations between frailty and neurocognitive decline in older breast cancer survivors, this is the first time this association has been described among young adult survivors of childhood and adolescent cancers. Additional research is warranted on interventions that may improve or halt progression to frailty and subsequently improve neurocognitive function.”
For more information:
AnnaLynn Williams, PhD, can be reached at St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis TN 38105; email: annalynn.williams@stjude.org.
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