The Relationships between Frailty and Quality of Life in Elderly Women with Breast Cancer
Keywords:Breast cancer in the elderly, quality of life, WHOQOL-OLD Module, PRISMA7 Frailty Index, frailty
Background: It is well known that oncologic management of elderly patients is complicated, and physicians should well define the ultimate goals when choosing treatment modalities. Cancer treatment should not necessarily focus on survival but aim for a good quality of life for the patient in light of their frailty.
Patients and Methods: This is a retrospective cross-sectional survey study. One hundred fifty-eight women with breast cancer participated in this study. The PRISMA-7 Frailty Index and WHOQOL-OLD Module assessed participants’ frailty and quality of life. SPSS 26.0 and Medcalc 14 [Acacialaan 22, B-8400 Ostend, Belgium] programs were used for statistical analyses. Statistically significant associations between the PRISMA-7 scale and the WHOQOL-OLD Module were assessed.
Results: Of the158 participants, the median age [min-max] was 71 [65-96] years, and 61.2% had stage I and II breast cancer. Lumpectomy was 61.1%, and 75% received chemotherapy-radiotherapy and hormone therapy. For the WHOQOL-OLD domains; financial status [p=0.001] with the sensory ability domain, work status [p<0.001] and education status[p=0.004] with the autonomy domain, education status [p=0.002] with PPF activity domain, education status [p=0.001] and work status [p=0.007] with the social participation domain, treatment modality [p=0.003] with death &dying domain, number of comorbidities [p=0.004] with intimacy domain statistically significant. The total score was associated with education status [p=0.005] and the number of comorbidities [p=0.010]. Frailty correlated positively with age [cut-off age 68 years; p<0.001]. Education status was inversely associated with increased frailty [p=0.003]. The relationship between the PRISMA-7 scale and the WHOQOL-OLD Module correlated negatively in five out of six dimensions except for the Intimacy domain.
Conclusions: It is necessary to design customized cancer management programs to improve specific components of elderly women with breast cancer with increased frailty by revealing the associations in domains of QoL.
Global Center Observatory [homepage on the internet]. Available from: https://gco.iarc.fr/.
Yancik RM, Ries L. Cancer and age: magnitude of the problem. In: Balducci L. LGH, EWB (ed) Comprehensive geriatric oncology. Harwood Academic Publishers, London, 1998; pp. 94-104.
Sudnongbua S, Long S. Quality of life among elderly people in Kampong Cham province, Cambodia. 2017. Available from: https://www.tm.mahidol.ac.th/seameo/2017-48-4/19-717221-884.pdf
World Health Organization [homepage on the internet]. WHOQOL-BREF. Available from: https://www.who.int/tools/whoqol/whoqol-bref
Institute on Aging N. Aging well in the 21 st century: Strategic directions for research on aging. Available from: https://www.nia.nih.gov/sites/default/files/2017-07/nia-strategic-directions-2016.pdf
Power M, Quinn K, Schmidt S; WHOQOL-OLD Group. Development of the WHOQOL-old module. Qual Life Res 2005; (10): 2197-214. https://doi.org/10.1007/s11136-005-7380-9 DOI: https://doi.org/10.1007/s11136-005-7380-9
Eser E, Eser S,Ozyurt CB, Fidaner C. Perception of quality of life by a sample of Turkish older adults: Whoqol-Old Project Turkish Focus Group Results. Turkish Journal of Geriatrics 2005; 8(4): 169-183.
Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States 2016; 25(7): 1029-36. https://doi.org/10.1158/1055-9965.EPI-16-0133 DOI: https://doi.org/10.1158/1055-9965.EPI-16-0133
Silvestri G, Pritchard R, Welch HG. Preferences for chemotherapy in patients with advanced non-small-cell lung cancer: descriptive study based on scripted interviews. BMJ 1998; 317(7161): 771-5. https://doi.org/10.1136/bmj.317.7161.771 DOI: https://doi.org/10.1136/bmj.317.7161.771
Wedding U, Pientka L, Höffken K. Quality-of-life in elderly patients with cancer: A short review. European Journal of Cancer 2007; 43: 2203-2210. https://doi.org/10.1016/j.ejca.2007.06.001 DOI: https://doi.org/10.1016/j.ejca.2007.06.001
Wildiers H, Heeren P, Puts M, et al. International society of geriatric oncology consensus on geriatric assessment in older patients with cancer. Journal of Clinical Oncology 2014; 32: 2595-2603. https://doi.org/10.1200/JCO.2013.54.8347 DOI: https://doi.org/10.1200/JCO.2013.54.8347
Fried LP, Tangen CM, Walston J, et al. Frailty in Older Adults: Evidence for a Phenotype, J Gerontol A Biol Sci Med Sci 2001; 56(3): M146-56. https://doi.org/10.1093/gerona/56.3.M146 DOI: https://doi.org/10.1093/gerona/56.3.M146
Moreno-Aguilar M, Garcia-Lara JMA, Aguilar-Navarro S, et al. The phenotype of frailty and health-related quality of Life. Journal of Frailty & Aging 2013; 1-6. https://doi.org/10.14283/jfa.2013.1 DOI: https://doi.org/10.14283/jfa.2013.1
Gill TM, Gahbauer EA, Han L, et al. Trajectories of disability in the last year of life. N Engl J Med 2010; (13): 1173-80. https://doi.org/10.1056/NEJMoa0909087 DOI: https://doi.org/10.1056/NEJMoa0909087
Bilotta C, Bowling A, Casè A, et al. Dimensions and correlates of quality of life according to frailty status: a cross-sectional study on community-dwelling older adults referred to an outpatient geriatric service in Italy. Health Qual Life Outcomes 2010; 8: 56. https://doi.org/10.1186/1477-7525-8-56 DOI: https://doi.org/10.1186/1477-7525-8-56
Kojima G, Iliffe S, Morris RW, et al. Frailty predicts trajectories of quality of life over time among British community-dwelling older people. Qual Life Res 2016; (7): 1743-50. https://doi.org/10.1007/s11136-015-1213-2 DOI: https://doi.org/10.1007/s11136-015-1213-2
Williams GR, Deal AM, Sanoff HK, et al. Frailty and health-related quality of life in elderly women with breast cancer. Support Care Cancer 2019; (7): 2693-98. https://doi.org/10.1007/s00520-018-4558-6 DOI: https://doi.org/10.1007/s00520-018-4558-6
Huang SM, Tseng LM, Chien LY, et al. Effects of non-sporting and sporting qigong on frailty and quality of life among breast cancer patients receiving chemotherapy. European Journal of Oncology Nursing 2016; 21: 257-265. https://doi.org/10.1016/j.ejon.2015.10.012 DOI: https://doi.org/10.1016/j.ejon.2015.10.012
Yaman H, Ünal Z. The validation of the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey. Electron Physician 2018; 10(9): 7266-72. https://doi.org/10.19082/7266 DOI: https://doi.org/10.19082/72
Hébert R, Raîche M, Dubois MF, et al. Impact of PRISMA, a coordination-type integrated service delivery system for frail older people in Quebec (Canada): a quasi experimental study. J Gerontol B Psychol Sci Soc Sci 2010; 65B(1): 107-18. https://doi.org/10.1093/geronb/gbp027 DOI: https://doi.org/10.1093/geronb/gbp027
Ganz PA, Guadagnoli E, Landrum MB, et al. Breast cancer in elderly women: Quality of life and psychosocial adjustment in the 15 months after diagnosis. Journal of Clinical Oncology 2003; 21: 4027-33. https://doi.org/10.1200/JCO.2003.08.097 DOI: https://doi.org/10.1200/JCO.2003.08.097
Sharma N, Purkayastha A. Factors affecting quality of life in breast cancer patients: A descriptive and cross-sectional study with review of literature. Journal of Mid-Life Health 2017; 8: 75-83. https://doi.org/10.4103/jmh.JMH_15_17 DOI: https://doi.org/10.4103/jmh.JMH_15_17
Hongthong D, Somrongthong R, Ward P. Factors Influencing the Quality of Life (Qol) Among Thai Older People in a Rural Area of Thailand. Iran J Public Health 2015(4): 479-85. Available from: http://ijph.tums.ac.ir
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012; 380(9836): 37-43. https://doi.org/10.1016/S0140-6736(12)60240-2 DOI: https://doi.org/10.1016/S0140-6736(12)60240-2
Edwards BK, Noone AM, Mariotto AB, et al. Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 2014; 120: 1290-1314. https://doi.org/10.1002/cncr.28509 DOI: https://doi.org/10.1002/cncr.28509
Montroni I, Rocchi M, Santini D, et al. Has breast cancer in the elderly remained the same over recent decades? A comparison of two groups of patients 70 years or older treated for breast cancer twenty years apart. J Geriatr Oncol 2014(3): 260-5. https://doi.org/10.1016/j.jgo.2014.02.006 DOI: https://doi.org/10.1016/j.jgo.2014.02.006
Sierink JC, de Castro SMM, Russell NS, et al. Treatment strategies in elderly breast cancer patients: Is there a need for surgery? Breast 2014; 23: 793-8. https://doi.org/10.1016/j.breast.2014.08.006 DOI: https://doi.org/10.1016/j.breast.2014.08.006
Hancke K, Denkinger MD, König J, et al. Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: A German clinical cohort study. Annals of Oncology 2009; 21: 748-53. https://doi.org/10.1093/annonc/mdp364 DOI: https://doi.org/10.1093/annonc/mdp364
Harrison CA, Parks RM, Cheung KL. The impact of breast cancer surgery on functional status in elderly women-A systematic review of the literature. European Journal of Surgical Oncology 2021; 47: 1891-9. https://doi.org/10.1016/j.ejso.2021.04.010 DOI: https://doi.org/10.1016/j.ejso.2021.04.010
de Haes JCJM, Curran D, Aaronson NK, Fentiman IS. Quality of life in breast cancer patients aged over 70 years, participating in the EORTC 10850 randomised clinical trial. European Journal of Cancer 2003; 39: 945-51. https://doi.org/10.1016/S0959-8049(03)00149-7 DOI: https://doi.org/10.1016/S0959-8049(03)00149-7
Cheng KKF, Lim EYT, Kanesvaran R. Quality of life of elderly patients with solid tumours undergoing adjuvant cancer therapy: A systematic review BMJ Open 2018; 8(1): e018101. https://doi.org/10.1136/bmjopen-2017-018101 DOI: https://doi.org/10.1136/bmjopen-2017-018101
Battisti NML, Reed MWR, Herbert E, et al. Bridging the age gap in breast cancer: Impact of chemotherapy on quality of life in elderly women with early breast cancer. European Journal of Cancer 2021; 144: 269-80. https://doi.org/10.1016/j.ejca.2020.11.022 DOI: https://doi.org/10.1016/j.ejca.2020.11.022
Campbell-Enns H, Woodgate R. The psychosocial experiences of women with breast cancer across the lifespan: a systematic review protocol. JBI Database System Rev Implement Rep 2015; 13: 112-21. https://doi.org/10.11124/jbisrir-2015-1795 DOI: https://doi.org/10.11124/jbisrir-2015-1795
Goerling U, Bergelt C, Müller V, Mehnert-Theuerkauf A. Psychosocial Distress in Women With Breast Cancer and Their Partners and Its Impact on Supportive Care Needs in Partners. Front Psychol 2020; 11: 564079. https://doi.org/10.3389/fpsyg.2020.564079 DOI: https://doi.org/10.3389/fpsyg.2020.564079
Akechi T, Okuyama T, Uchida M, et al. Perceived needs, psychological distress and quality of life of elderly cancer patients. Jpn J Clin Oncol 2012; 42(8): 704-10. https://doi.org/10.1093/jjco/hys075 DOI: https://doi.org/10.1093/jjco/hys075
Wittmann-Vieira R, Goldim JR. Bioethics and palliative care: decision making and quality of life* Bioética e cuidados paliativos: tomada de decisões e qualidade de vida Bioética y cuidados paliativos: toma de decisiones y calidad de vida. https://doi.org/10.1590/S0103-21002012000300003 DOI: https://doi.org/10.1590/S0103-21002012000300003
Mahfouz MA, Almaghrabi MY. Quality of life for elderly breast cancer patients: A new regard. Translational Cancer Research 2020; 9: S122-S125. https://doi.org/10.21037/tcr.2019.07.39 DOI: https://doi.org/10.21037/tcr.2019.07.39
Chambergo-Michilot D, Corcuera-Ciudad R, Runzer-Colmenares FM, et al. Pain management, activities of daily living and the assessment of the WHOQOL-OLD module: results of a cross-sectional analysis of a cohort of older men with oncological diagnoses. Journal of Gerontology and Geriatrics 2022; 70: 31-39. https://doi.org/10.36150/2499-6564-N395 DOI: https://doi.org/10.36150/2499-6564-N395
Oliveira Araújo Firmo JI, Uchôa EI, Saúde, das Graças Uchôa Penido Fonseca M, Loyola Filho II. Role of autonomy in self-assessment of health by the elderly. Rev Saúde Pública 2010; 44(1). Available from: https://www.scielo.br/j/rsp/i/2010.v44n1/
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