Concrete resource needs and frailty among older adults with cancer: The Cancer and Aging Resilience Evaluation (CARE) Registry.

Abstract

6546 Background: Concrete resource needs (CRN: insecurity of food, utilities, and/or housing) are important and modifiable indicators of poverty. Prior work among adults with chronic cardiometabolic diseases demonstrates that CRN-targeted interventions improve health outcomes. Poverty is associated with inferior health outcomes among patients with cancer. Frailty is a recognized state of increased vulnerability and is associated with increased toxicities from cancer therapies and reduced survival. The prevalence of CRN among older adults with cancer and its role in modifying the risk of frailty remains unknown. We aimed to (1) describe the prevalence of CRN and (2) examine the association between CRN and frailty among older adults with cancer. Methods: The CARE registry prospectively enrolls older adults (≥60y) with cancer seen at UAB as new patients. Single-item screening measures captured food, housing and utility insecurity in addition to the baseline CARE geriatric assessment beginning 8/2020. The 44-item CARE Frailty Index (based on the principles of deficit accumulation) was used to define frailty. Multivariable analysis examined association of CRN with frailty, adjusting for age, race, sex, education, employment, marital status, and cancer type and stage. Results: The cohort included 485 participants with a mean age at enrollment of 69y; 63.7% were male; 20.4% were non-Hispanic Black. The most prevalent cancer types included colorectal (33.0%), pancreatic (16.3%) and hepatobiliary (12.2%) cancers. Median time from cancer diagnosis to study enrollment was 35 days. The overall prevalence of CRN was 6.6% (insecurity of housing [2.9%], food [4.3%], and utilities [4.1%]). Participants with CRN were less educated ( < HS: 21.9% vs. 9.9%, p= 0.01), more often widowed/divorced (53.1% vs. 35.1%, p= 0.003) and more likely to be disabled (43.8% vs. 12.4%, p< 0.001). Overall, 33.8% of patients were frail. In multivariable analysis, patients with CRN had a 6.24 higher odds of frailty (95% CI 1.72-22.7, p= 0.005) compared to those without CRN after adjustment for above-mentioned covariates. Conclusions: CRN represents a novel exposure that is independently associated with frailty. In order to inform a CRN-targeted intervention for the growing number of older adults with cancer, future work is warranted to examine the CRN construct in this population, including examination of more detailed screening measures and CRN-associated cancer outcomes.