Alcohol consumption in older cancer survivors: An analysis of adherence to the World Cancer Research Fund and American Institute for Cancer Research guidelines.

Cancer is a disease associated with aging, with approximately 60% of cancer diagnoses occurring in patients age 65 and older. Of 10.8 million cancer survivors in the US, approximately 6.8 million are age 65 or older. With the aging of the baby boomer population and rises in life expectancy, the number of cancer cases and the number of cancer survivors is anticipated to grow over the coming decades.1 Optimal care of this growing population of older adult cancer survivors will require an understanding of the interaction between cancer, cancer therapy, and the aging process. In particular there is a gap in knowledge regarding whether cancer and/or cancer treatment accelerates the aging process, and if so whether the accelerated aging is transient or permanent. This lecture will provide an overview of the available data regarding the intersection between aging and survivorship, as well as specific considerations in the assessment and treatment of older adult survivors. Cancer and cancer treatment has a potential long term impact on the health status and physical function of older adults.2–3 The Health and Retirement study evaluated the health and functional status of older cancer survivors in comparison to controls. Older cancer survivors were less likely to report excellent or good health (P<0.001), reported more mobility limitations (P<0.001), and reported more limitations with activities of daily living (P=0.01). Among older cancer survivors, obesity, lack of exercise, and poor diet are associated with a poorer quality of life.4 A randomized study tested the benefits of an exercise and diet intervention in older cancer survivors and demonstrated that the intervention was associated with a decrease in self-reported functional decline.5 Older cancer survivors have an increased number of comorbid conditions in comparison to individuals without a history of cancer.2 The NIA/NCI Collaborative Study on Cancer and Comorbidity in the Elderly provided summary data on the comorbidity of 7,600 patients age 55 and older with a history of cancer. The most common comorbid conditions included hypertension (43%), heart conditions (39%) and arthritis (35%).6 Patients may be at increased risk for specific comorbid conditions based on their preexisting comorbid conditions and the therapeutic exposures received. For example, therapy with doxorubicin is associated with an increased risk of congestive heart failure and cardiomyopathy.7–8 Risk factors include a history of diabetes mellitus, coronary artery disease, and hypertension. Therapy with an aromatase inhibitor is associated with a loss in bone mineral density and this risk is most pronounced in patients with pre-existing bone loss.9 These examples highlight the need to better understand the association between a history of cancer, patient characteristics (including pre-existing comorbid conditions), specific therapeutic exposure, and the subsequent development or acceleration of comorbid conditions. Although our knowledge of the potential survivorship issues facing older adults is growing, several gaps in knowledge remain.10 As the number of cancer survivors is on the rise, it is critical to improve our evidence-based knowledge to identify and reduce the risk of late side effects from treatment. Prospective longitudinal studies of the long term impact of cancer therapies and interventions to decrease the risk are needed.

The 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines encourage cancer survivors to follow its cancer prevention recommendations. We evaluated whether adherence to the WCRF/AICR guidelines for cancer prevention was associated with lower mortality among older female cancer survivors. From 2004 to 2009, 2,017 participants in the Iowa Women's Health Study who had a confirmed cancer diagnosis (1986-2002) and completed the 2004 follow-up questionnaire were followed. Adherence scores for the WCRF/AICR guidelines for body weight, physical activity, and diet were computed assigning one, 0.5 or 0 points to each of eight recommendations depending on the degree of adherence. All-cause (n = 461), cancer-specific (n = 184), and cardiovascular disease (CVD)-specific mortality (n = 145) were compared by the total adherence score and by adherence scores for each of the three components of the recommendations. Women with the highest (6-8) versus lowest (0-4) adherence score had lower all-cause mortality [HR = 0.67; 95% confidence of interval (CI), 0.50-0.94]. Meeting the physical activity recommendation was associated with lower all-cause (Ptrend < 0.0001), cancer-specific (Ptrend = 0.04), and CVD-specific mortality (Ptrend = 0.03). Adherence to dietary recommendations was associated with lower all-cause mortality (Ptrend < 0.05), whereas adherence to the body weight recommendation was associated with higher all-cause mortality (Ptrend = 0.009). Adherence to the WCRF/AICR guidelines was associated with lower all-cause mortality among older female cancer survivors. Adherence to the physical activity recommendation had the strongest association with lower all-cause and disease-specific mortality. Older cancer survivors may decrease their risk of death by leading a healthy lifestyle after a cancer diagnosis.

Association of intraindividual variability in simple reaction time with balance and falls in older cancer survivors: A secondary analysis.

The association between mental health, social support and physical health outcomes among older female cancer survivors

173 Background: The majority of cancer survivors are older adults (≥65 years), but their lifestyle behaviors are understudied. Factors associated with improved physical and mental well-being in older female cancer survivors are not well understood. The objective of this study was to evaluate the factors associated with physical and mental well-being in older female cancer survivors, including the role of malnutrition, physical activity, and level of emotional support. Methods: Older female cancer survivors (n=171) completed surveys to assess health related quality of life (HRQoL) using SF-36, malnutrition screening tool (MST), and physical activity. Demographics were also collected. The data was analyzed using descriptive analyses, correlations, and ANCOVAs. Survivors were divided into four phenotypes for analysis using the SF-36 physical and mental composite scores (PCS; MCS) stratified based on the sample’s mean scores (table). Factors associated with the four groups were assessed including demographic characteristics, cancer type, level of emotional support, risk for malnutrition, and physical activity. Results: The majority of the cohort (mean age=74.5 years) were white and highly educated. 68.4% were breast cancer survivors, with 10.5% hematologic malignancy survivors, 5.3% gynecologic malignancy survivors, and 15.8% other. Mean PCS and MCS were 41.94 and 48.47, respectively, comparable to general older adult population means. When divided into four groups based on PCS/MCS, there were no significant differences by demographic characteristics or cancer type. Survivors with higher emotional support scores had significantly higher PCS/MCS scores (p&lt;0.001). There was also a significant difference in risk for malnutrition, as those with high PCS/MCS were at lower risk for malnutrition (p≤0.001). Survivors with low PCS/MCS engaged in less moderate exercise as compared to those with high PCS/MCS (p=0.028). Conclusions: This study suggests that lower risk for malnutrition as well as higher levels of emotional support are associated with higher physical and mental well-being in older female cancer survivors. These are two potential modifiable targets for interventional studies to optimize physical and mental well-being among older cancer survivors. [Table: see text]

Older cancer survivors in general are at greater risk for cancer-related cognitive impairment (CRCI), yet few studies have explored its association with health outcomes. This study examined the association between subjective and objective measures of cognitive function and physical function, frailty, and quality of life (QoL) among older breast cancer survivors. Older breast cancer survivors who reported cognitive concerns completed surveys on patient-reported cognitive function, physical function, frailty, and QoL as well as objective tests of visuospatial working memory and sustained attention. Data were analyzed using descriptive statistics and separate linear regression models. A total of 219 female breast cancer survivors completed the study. Perceived cognitive abilities were associated with better physical function, frailty, and QoL (p ≤ 0.001) while cognitive concerns were negatively related with these metrics (p ≤ 0.001). Poorer visuospatial working memory and sustained attention were linked to increased frailty (p ≤ 0.001-0.01), whereas poorer sustained attention was associated with poorer physical function (p < 0.01). Older breast cancer survivors with perceived cognitive impairment and poorer cognitive performance reported poorer physical functioning, increased frailty, and poorer QoL. These findings underscore the importance of assessing cognitive concerns and their associated outcomes in older breast cancer survivors.

Background: In the United States, over 60% of breast cancer survivors are 65 years and older; however, little is known about patient-reported symptoms and the effect that cancer treatments could have on survivors years after their primary treatment and diagnosis. This study evaluated perceived cognitive function in older breast cancer survivors and whether prior chemotherapy was associated with cognitive outcomes. Methods: Breast cancer patients aged 65 years and older, diagnosed 2012-2013, with local and regional stage disease, were identified through the linked Texas Cancer Registry-Medicare dataset (TCR). Survivors were mailed a survey to assess their cognitive function through the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog V3) instrument (section G of the survey). The survey also collected demographic and clinical data and was collected between April 2018 and October 2019. Utilizing the data from the self-administered questionnaires, TCR, and Medicare claims, the cognitive function and quality of life among elderly patients were evaluated to assess whether prior chemotherapy and/or endocrine therapy impacts long-term health. A linear regression model was used to examine the significance of receiving chemotherapy to FACT-Cog V3 primary score while controlling for respondent sociodemographic and clinical variables. Results: Of 4,448 eligible patients, 1,954 (43.9% response rate) responded to section G. Of these, 1,065 respondents completed all 4 sections, 37 questions. Eighty of those 1065 respondents self-reported disease recurrence which excluded them from the analyses in order to avoid biases, leaving a total of 985 cases for this study. Median time from diagnosis to survey completion was 68 months (IQR 62-73). Receipt of chemotherapy was associated with a slightly lower FACT-Cog score. In total, those with chemotherapy scored, on average, 105.6 (SD 21.2) while those without scored 107.1 (SD 22.3). The largest difference in mean scores is attributed to the Perceived Cognitive Impairment subsection (scored from 0-72) where those with chemotherapy scored, on average, 57.2 (SD 13.8) and those without scored 58.7 (SD 14.0). Responsible Conduct Of Research: We need to ensure that the privacy of our patients will be protected when using their information from the surveys. Conclusion: Adjuvant chemotherapy was associated with more self-reported cognitive impairment in older breast cancer survivors, even 5-6 years after diagnosis. However, the difference between patients who received chemotherapy versus those who did not was modest, suggesting limited clinical significance. Further research is needed to determine the long-term impact of cancer treatments, particularly in older cancer survivors. Citation Format: Rachel Kim, Kai-Ping Liao, Susan Peterson, Daria Zorzi, Liang Li, Mariana Chavez MacGregor, Sharon Giordano. Cognitive function in older breast cancer survivors after chemotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7454.

Background and Purpose: Executive function (EF) is associated with falls and impaired gait in older adults. Performance on a measure of EF, the Trail Making Test Part B (TMT-B), may be able to differentiate between physical mobility and balance in older cancer survivors. The purpose of this study was to describe the demographic, disease-associated, and mobility differences in 2 groups of older cancer survivors based on the ability to complete TMT-B. Methods: Physical mobility and cognition was assessed in 50 older (aged 65+ years) cancer survivors. Group assignment was by TMT-B completion status (completers/noncompleters). Between-groups comparisons were performed on measures of physical mobility, balance, gait, and self-efficacy using nonparametric statistics. Results: Sixteen (32%) older cancer survivors were unable to complete TMT-B. Significant differences were found (P &lt; .05) on all Timed Up and Go (TUG) measures in noncompleters versus completers: TUG (12.10 seconds vs 9.28 seconds), TUG-manual (12.81 seconds vs 10.88 seconds), TUG-cognitive (14.35 seconds vs 10.98 seconds). Noncompleters had significantly worse (P &lt; .05) scores on the Short Physical Performance Battery, Fullerton Advanced Balance Scale, 30-second timed chair rise, balance confidence, falls self-efficacy, and all gait speed (usual, fast, dual-task) measures. Discussion: Older cancer survivors unable to complete TMT-B had worse performance in mobility, balance, strength, and dual-task activities that involve the increased demand of cognitive function. Executive function should be screened as a part of the falls risk management in older cancer survivors. Conclusion: Physical mobility, balance, and function are significantly more impaired in older cancers survivors who are unable to complete the TMT-B cognitive measure.

Impact of breast cancer survivorship on quality of life in older women

BackgroundThough telehealth has been a promising avenue for engaging cancer survivors with health care and lifestyle programming, older and rural-dwelling cancer survivors may have additional challenges in accessing digital devices and tools that have not yet been described. This study aimed to use a robust, nationally representative sample collected in 2022 to provide an updated view of digital technology use and the use of technology for health in this population.ObjectiveThis study aimed to examine the prevalence of digital technology use for health-related activities among older cancer survivors in both rural and urban settings. The primary outcomes of interest included (1) internet access and use for health-related activities, (2) digital device ownership and use as a tool for health behaviors, (3) use of social media for health, and (4) use of telehealth.MethodsA cross-sectional analysis of the National Cancer Institute’s Health Information National Trends Survey Cycle 6 (HINTS 6) was completed to examine the prevalence of digital technology use among older cancer survivors. For analysis, the sample was restricted to cancer survivors over the age of 60 years (n=710). Unadjusted and adjusted logistic regression models were used to test the association between rurality and digital health tool use.ResultsOverall, 17% (125/710) of the sample lived in a rural area of the United States and the mean sample age was 73 (SD 8.2) years. Older cancer survivors, regardless of rural-urban status, reported a high prevalence of internet usage (n=553, 79.9%), digital device ownership (n=676, 94.9%), and social media use (n=448, 66.6%). In unadjusted models, rural survivors were less likely than urban survivors to report that they had used a health or wellness application in the previous year (odds ratio [OR] 0.56, 95% CI 0.32-0.97; P=.04). In adjusted models, rural survivors were more likely to report that they had shared personal health information on social media (OR 2.64, 95% CI 1.13-6.19; P=.03). There were no differences in the proportion of rural and urban respondents who reported receiving health services through telehealth in the previous year.ConclusionsRegardless of the residential status, older cancer survivors report high internet and technology use for health-related activities. These results show promise for the feasibility of using digital technologies to implement supportive care and wellness programming with older cancer survivors.

Longitudinal trajectories of frailty and cognitive decline among older Korean cancer survivors

Frailty in older adult cancer survivors after cancer treatments is associated with various health outcomes. However, there is less agreement on how frailty affects symptoms and health-related quality of life (HRQOL). This systematic review and meta-analysis aimed to evaluate the current literature on frailty, symptoms, and HRQOL, as well as the associations of frailty with these factors in older adult cancer survivors with chemotherapy. A review was conducted on peer-reviewed publications from 2008 to 2023, using seven electronic databases. Meta-analyses were performed using random effects models to determine pooled effect estimates for frailty prevalence, symptom severity, and HRQOL scores. A total of 26 studies involving older cancer survivors were included in the analysis. Most of these studies were conducted in Western countries and focused on White survivors, particularly those with breast cancer. The mean pooled prevalence of frailty was 43.5%. Among frail survivors, the most common symptoms reported after cancer treatments were pain (36.4%), neuropathy (34.1%), and fatigue (21.3%). Frailty was associated with higher pooled mean symptom severity (B = 1.23, p = 0.046) and lower functional HRQOL (B = -0.31, p = 0.051, with marginal significance) after cancer treatments. Frail older cancer survivors are at high risk of adverse symptoms and poor HRQOL after cancer treatment. Further research on screening for frailty is needed to prevent older adults from developing worse symptoms burden and maintain HRQOL. It is also essential to understand the mechanisms of the associations between frailty, symptoms and HRQOL in this population.

Healthy lifestyles including maintaining a normal weight, consuming a healthy diet, and being physically active can improve prognosis and health-related quality of life (HRQoL) among cancer survivors. The largest proportion of cancer survivors are older adults (≥ 65years), yet their lifestyle behaviors are understudied. This study sought to examine the lifestyle behaviors (maintaining healthy weight, diet quality, physical activity) of older female cancer survivors and identify associations with HRQoL. Older female cancer survivors (n = 171) completed surveys to assess HRQoL (RAND-36), unintentional weight loss, body mass index (BMI), diet quality (HEI-2015), and physical activity. Demographic information and medical record data were also collected. Descriptive analyses, correlations, and stepwise linear regressions were utilized. Physical and mental HRQoL of the sample (mean age = 74.50years) were low: 41.94 ± 10.50 and 48.47 ± 7.18, respectively, out of 100. Physical activity was low: 75.3%, 54.2%, and 68.1% reported no strenuous, moderate, and mild physical activity, respectively. Mean BMI was 27.71 ± 6.24 (overweight) with 64% of the participants being overweight or obese. Mean HEI-2015 scores were 66.54 ± 10.0. Engagement in moderate physical activity was associated with higher physical HRQoL (β = 0.42, p = 0.004). Being white (β = 0.53, p < 0.001), older (β = 0.27, p = 0.025), and having higher HEI scores (β = 0.30, p = 0.011) were associated with higher mental HRQoL. Older cancer survivors report poor diet quality, high rates of being overweight or obese, and low levels of physical activity that impact their HRQoL. Results indicate the need for tailored health coaching for older cancer survivors regarding their lifestyle behaviors to improve prognosis and HRQoL.

One area within geriatric oncology that is understudied and undertreated is the dietary quality of older cancer survivors. Most older adults with cancer experience nutritional deficits due to their age and cancer treatment. Research has shown the impact of competing comorbidities, polypharmacy, and decline in functional and cognitive status on older adults’ nutritional needs. This study sought to examine the diet quality of older female cancer survivors, and its association with inflammatory markers and physical functioning. Participants completed surveys online, by mail, or phone. Additional participant information was obtained through medical records. Descriptive statistics, Pearson’s correlations, forward linear regressions were used to analyze these data. Older female cancer survivors (≥65) that had completed their initial cancer treatment in the past 5 years were recruited through cancer clinic visits and medical records. The study was conducted from November 2018 through January 2020. Self-reported physical functioning (RAND-36), diet quality (DHQ-II, HEI-2015), and BMI were obtained from surveys. Participant diagnosis, comorbidities, and inflammatory marker (c-reactive protein (CRP)) were obtained through electronic medical records; albumin was collected as a marker correlated with inflammation. The average age of participants (n = 171) was 73.6 ± 8.4 years. Mean physical functioning score was 60 ± 24 out of 100. Mean total HEI scores were 66.39 + 10.0 out of 100. Positive correlations were observed between total HEI scores and physical functioning, self-rated health, albumin, education, and income. Negative correlations were observed between physical functioning and BMI, self-rated health, albumin, and age. Regressions indicated that individuals who had higher HEI scores were more likely to report higher physical functioning (β = 0.38, P < 0.001). Identifying dietary quality and markers to overall assess inflammation is pertinent to improve the long-term health of cancer survivors. The strong correlations between physical function, HEI, and albumin demonstrates the relationship albumin has with inflammation and its subtle impact it can have on older cancer survivors. Along with CRP, serum albumin should be interpreted in the context of the patient’s overall health. Future larger cohort studies of older cancer survivors with longitudinal measurements are warranted.

Dietary supplements are widely used by cancer survivors. However, health effects among older cancer survivors are unclear. We used the Iowa Women's Health Study, a prospective cohort study with 2,118 postmenopausal women with a confirmed cancer diagnosis (1986-2002), to evaluate the association between postdiagnosis dietary supplement use assessed in 2004 and subsequent all-cause mortality. Risk of death was evaluated using multivariable-adjusted Cox proportional hazards regression. We performed stratified analyses by diet quality score, dietary micronutrient intake, and perceived general health. Through 2010, 608 deaths were identified. Approximately 85% of the cancer survivors used dietary supplements. Overall supplement use and multivitamin use were not associated with mortality. Iron supplement use was associated with 39% higher risk of death [95% confidence interval (CI), 1.09-1.77]. This association was stronger among survivors with deteriorating general health. Folic acid supplement use was associated with higher risk of death, only among survivors reporting low-quality diets (HR, 2.33; 95% CI, 1.33-4.08; P interaction = 0.006). Multivitamin use and using a greater number of supplements was associated with a trend towards higher mortality only among those with poor diet quality. Using vitamin E supplements in combination with multivitamin was associated with lower risk of death only among survivors with higher dietary vitamin E intake (HR, 0.61; 95% CI, 0.39-0.94; P interaction = 0.02). Postdiagnosis supplement use was associated with higher mortality among older female cancer survivors with poor general health and/or poor dietary intake. The association between postdiagnosis dietary supplement use and mortality may differ by diet quality and health status among older female cancer survivors.