Black older adults with cancer more likely to be frail, have functional impairments
Older Black adults with newly diagnosed gastrointestinal malignancies appeared more likely to be frail and report functional impairments than their white counterparts, according to study results published in Cancer.
Rationale and methods
“Despite advances in cancer therapies, racial disparities in cancer outcomes persist. However, the mechanisms for these disparities remain uncertain," Grant R. Williams, MD, MSPH, assistant professor in the division of hematology and oncology and director of the cancer and aging program at The University of Alabama at Birmingham, told Healio.
Researchers sought to assess racial differences in frailty and geriatric assessment impairments among an unselected cohort of 553 older adults (mean age, 69.9 years; 57.5% men; 23% Black) with newly diagnosed gastrointestinal malignancies included in the Cancer and Aging Resilience Evaluation (CARE) Registry. All adults self-reported as Black or white and completed a geriatric assessment before treatment initiation.
For the purpose of this study, researchers defined frailty using a frailty index based on the deficit accumulation method.
Key findings
Overall, primary cancer diagnoses included colorectal (32%), followed by pancreatic (27%) and hepatobiliary (18%).
Results showed Black adults were more likely to be frail (50% vs. 32.7%; P < .001) and experience limitations in daily living activities (27.3% vs. 14.1%; P = .001), instrumental activities of daily living (64.8% vs. 47.3%; P = .002) and walking one block (62.5% vs. 48.2%; P = .004), even after researchers adjusted for age, sex, education, cancer type and comorbidity.
“Black participants were 2.6 times more likely to be frail compared with white participants and approximately twice as likely to report limitations that are known risk factors for increased adverse events when undergoing cancer treatment,” Williams said. “Some systematic differences between the groups were expected, but it was very surprising to see such large magnitudes of differences. In addition, we hypothesized that if differences existed in these factors, it may be attributable to differences in comorbid conditions, but this did not seem to be the case as the comorbidity profiles were similar across groups, with the exception of hypertension and glaucoma.”
Implications
As frailty and the other limitations are strongly associated with adverse outcomes in cancer populations, they may in part explain racial disparities in cancer outcomes, Williams said.
“In future research, we plan to evaluate whether these limitations and impairments identified in our study may be mediators/moderators of racial disparities in cancer outcomes, such as survival, and serve to explain at least partially some of the known disparities in outcomes in the field,” Williams added.
These findings provide a mandate for change, Jana Wieland, MD, researcher in the department of medicine, Barbara L. Jordan, MA, an education administrator, and Aminah Jatoi, MD, a medical oncologist, all at Mayo Clinic in Rochester, Minnesota, wrote in an accompanying editorial.
“Health care providers should work to incorporate geriatric assessment-driven interventions into clinical practice for older, frail patients — including those who appear to be at ostensibly higher risk because of racial considerations — with the goal of lessening these patients’ side effects and improving their cancer outcomes,” Wieland and colleagues wrote.
References:
Wieland J, et al. Cancer. 2022;doi:10.1002/cncr.34179.
Williams GR, et al. Cancer. 2022;doi:10.1002/cncr.34178.
For more information:
Grant R. Williams, MD, MSPH, can be reached at The University of Alabama at Birmingham, 1600 7th Ave. South, Lowder 500, Birmingham, AL 35233; email: grwilliams@uabmc.edu.
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