Depressive Symptoms and Poor Functional Status are Factors Associated with Frailty and Decreased Quality of Life in Thai Older Breast Cancer Survivors:

Arpa Satayasansakul; Prasert Assantachai; Suebwong Chuthapisith; Monthira Thammasalee; Thapanee Chimchanwet; Suthipol Udompunturak

doi:10.33192/smj.v77i1.271452

Authors

Arpa Satayasansakul Geriatric Department, Ratchaphiphat Hospital, Bangkok, Thailand
Prasert Assantachai Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Suebwong Chuthapisith Division of Head, Neck, and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Monthira Thammasalee Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Thapanee Chimchanwet Division of Head, Neck, and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Suthipol Udompunturak Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v77i1.271452

Keywords:

Breast cancer survivors, frailty, quality of life, older adults, depression

Abstract

Objective: This study examines the prevalence and clinical factors associated with frailty, poor health-related quality of life (HR-QoL), and the combined presence of both in older breast cancer survivors.

Materials and Methods: In this cross-sectional study, 230 BSC patients aged > 60 years and > 3 years cancer free were recruited. Frailty and HR-QoL were evaluated using the Fried Frailty Phenotype and the Functional Assessment of Cancer Therapy-Breast (FACT-B), respectively. As well, overall health status was assessed through a comprehensive geriatric assessment (CGA). Logistic regression was used to identify factors independently associated with frailty and reduced HR-QoL.

Results: Of all 230 BCS, 16.5% were frail, 47.4% were pre-frail, and 36.1% were robust. Depressive symptoms were strongly associated with frailty (OR: 13.1, 95% CI: 4.04–42.74), indicating that individuals with these symptoms were 13 times more likely to be frail. Low physical activity (OR: 5.7, 95% CI: 2.1–15.08) and unmarried status (OR: 2.75, 95% CI: 1.47–19.57) were also significant predictors of frailty. Frail participants had notably lower HR-QoL scores than those who were non-frail.

Conclusion: This study highlights the significant impact of depressive symptoms, reduced physical function, and social factors on frailty and HR-QoL in old-age BCS. Comprehensive geriatric assessment, including mental health and social support evaluations, are essential for early identification and intervention. Further research should focus on additional interventions aimed at reducing frailty and enhancing HR-QoL.

References

Proietti M, Cesari M. Frailty: What Is It? Adv Exp Med Biol. 2020; 1216:1-7.

Rohrmann S. Epidemiology of Frailty in Older People. Adv Exp Med Biol. 2020;1216:21-27.

Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394:1365-75.

Kojima G, Iliffe S, Jivraj S, Walters K. Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis. J Epidemiol Community Health. 2016;70:716-21.

Hoogendijk EO, Suanet B, Dent E, Deeg DJ, Aartsen MJ. Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam. Maturitas. 2016;83:45-50.

Sareh S, Ugarte R, Dobaria V, Hadaya J, Sirody J, McCallum JC, et al. Impact of Frailty on Clinical and Financial Outcomes Following Minor Lower Extremity Amputation: A Nationwide Analysis. Am Surg. 2020;86: 1312-7.

Bennett JA, Winters-Stone KM, Dobek J, Nail LM. Frailty in older breast cancer survivors: age, prevalence, and associated factors. Oncol Nurs Forum. 2013;40:E126-34.

Stover AM, Mayer DK, Muss H, Wheeler SB, Lyons JC, Reeve BB. Quality of life changes during the pre- to post diagnosis period and treatment-related recovery time in older women with breast cancer. Cancer. 2014;120:1881-9.

Singtaweesuk N, Thanoi W, Vongsirimas N, Kesornsri S, Klainin-Yobas P. Factors predicting psychological well-being among survivors of breast cancer in a tertiary care hospital, Thailand. Siriraj Med J. 2024;76(5):244-54.

Lopes JV, Bergerot CD, Barbosa LR, Calux N, Elias S, Ashing KT, et al. Impact of breast cancer and quality of life of women survivors. Rev Bras Enferm. 2018;71:2916-21.

Moshina N, Falk RS, Hofvind S. Long-term quality of life among breast cancer survivors eligible for screening at diagnosis: a systematic review and meta-analysis. Public Health. 2021;199:65-76.

Williams GR, Deal AM, Sanoff HK, NyropKA, Guerard EJ, Pergolotti M, et al. Frailty and health-related quality of life in older women with breast cancer. Support Care Cancer. 2019;27:2693-8.

Ho PJ, Gernaat SAM, Hartman M, Verkooijen HM. Health-related quality of life in Asian patients with breast cancer: a systematic review. BMJ Open. 2018;8:e020512.

Pondé NF, Zardavas D, Piccart M. Progress in adjuvant systemic therapy for breast cancer. Nat Rev Clin Oncol. 2019;16:27-44.

Ahles TA, Schofield E, Li Y, Ryan E, Root JC, Patel SK, et al. Relationship between cognitive functioning and frailty in older breast cancer survivors. J Geriatr Oncol. 2022;13:27-32.

Jirakulsawat A, Noocharoen A, Srinimit B, Anakmeteeprugsa S. Assessment on knowledge and satisfaction level of delirium video for education in geriatric patients undergoing elective noncardiac surgery. Siriraj Med J. 2024;76(7):415-21.

Lemij AA, Liefers GJ, Derks MGM, Bastiaannet E, Fiocco M, et al. Physical Function and Physical Activity in Older Breast Cancer Survivors: 5-Year Follow-Up from the Climb Every Mountain Study. Oncologist. 2023;28:e317-e23.

Farrugia M, Erickson K, Wendel E, Platek ME, Ji W, Attwood K, et al. Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy. Cancers (Basel). 2021;13(7):1638.

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J GerontolA Biol Sci Med Sci. 2001;56(3):M146-56.

Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997;15:974-86.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-83.

Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15:1021-7.

Wongpakaran N, Wongpakaran T, Kuntawong P. Evaluating hierarchical items of the geriatric depression scale through factor analysis and item response theory. Heliyon. 2019;5:e02300.

Nestlé Nutrition Institute, Mini Nutritional Assessment form: Thai version, 2021. https://www.mna-elderly.com/sites/default/files/2021-10/mna-mini-thai.pdf (accessed 12 January 2024).

Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1998;10:61-63.

Graf C. The Lawton instrumental activities of daily living scale. Am J Nurs. 2008;108:52-62.

Parajuli J, Berish D, Valenti KG, Jao YL. Prevalence and predictors of depressive symptoms in older adults with cancer. J Geriatr Oncol. 2021;12: 618-22.

Zhang Y, Jiang X. The effects of physical activity and exercise therapy on frail elderly depression: A narrative review. Medicine (Baltimore). 2023;102:e34908.

Zhang X, Edwards BJ. Malnutrition in Older Adults with Cancer. Curr Oncol Rep. 2019;21:80.

Varghese FP, Brown ES. The Hypothalamic-Pituitary-Adrenal Axis in Major Depressive Disorder: A Brief Primer for Primary Care Physicians. Prim Care Companion J Clin Psychiatry. 2001;3:151-5.

Song Y, Cao H, Zuo C, Gu Z, Huang Y, Miao J, et al. Mitochondrial dysfunction: A fatal blow in depression. Biomed Pharmacother. 2023;167:115652.

Lee CH, Giuliani F. The Role of Inflammation in Depression and Fatigue. Front Immunol. 2019;10:1696.

Soysal P, Veronese N, Thompson T, Kahl KG, Fernandes BS, Prina AM, et al. Relationship between depression and frailty in older adults: A systematic review and meta-analysis. Ageing Res Rev. 2017;36:78-87.

Saracino RM, Nelson CJ. Identification and treatment of depressive disorders in older adults with cancer. J Geriatr Oncol. 2019;10:680-4.

Frick E, Tyroller M, Panzer M. Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient center. Eur J Cancer Care (Engl). 2007;16:130-6.

KT Han, Kim SJ, Song H, Chun SY, Kim CO, Kim JS, et al. Associations between quality of life and marital status in cancer patients and survivors. Asian Pac J Cancer Prev. 2014;15:5287-91.

Phenwan T, Peerawong T, Tulathamkij K. The Meaning of Spirituality and Spiritual Well-Being among Thai Breast Cancer Patients: A Qualitative Study. Indian J Palliat Care. 2019;25:119-23.

Qiu J, Yan M, Chen W, Gao S, Liu S, Shi S, et al. Prevalence and correlates of major depressive disorder in breast cancer survivors in Shanghai, China. Psychooncology. 2012;21(12):1331-7.

Kojima G, Walters K, Iliffe S, Taniguchi Y, Tamiya N. Marital status and risk of physical frailty: a systematic review and meta-analysis. J Am Med Dir Assoc. 2020;21:322-30.

Williams GR, Deal AM, Sanoff HK, Nyrop KA, Guerard EJ, Pergolotti M, et al. Frailty and health-related quality of life in older women with breast cancer. Support Care Cancer. 2019;27(7):2693-8.