Health-related and sociodemographic factors associated with physical frailty among older cancer survivors.

OBJECTIVE: The purpose of this study was to examine factors associated with frailty in older cancer survivors. MATERIALS AND METHODS: This is a cross-sectional study using data from the National Social Health and Aging Project (NSHAP) Wave 2, and includes an in-home, nationally representative sample of community-dwelling adults ≥50 years and older from the United States. Frailty score was computed for each individual using a modified 4-point scale based on the phenotypic frailty. Ordinal logistic regression was used to characterize the association between health-related, sociodemographic factors and frailty. RESULTS: Among the 3377 participants, 461 were cancer survivors (answered "yes" to "ever have cancer other than skin cancer"). A final sample of 394 cancer survivors were included: 59 participants (16.1%) were frail, 219 participants were pre-frail (59.8%), and 88 participants were non-frail (24.0%). The univariate analyses showed increasing age (OR 1.48; CI 1.29-1.72; p-value <.001), comorbidities (OR 1.43; CI 1.25-1.64; p-value <.001), depression (OR 1.27; CI 1.19-1.35; p-value <.001) and low mobility (OR 1.55; CI 1.37-1.78; p-value <.001) were associated with frailty. Participants with high self-rated (good/very good/ excellent) physical health (OR 0.18; CI 0.11-0.30; p < .001) and mental health (OR 0.27; CI 0.15-0.50; p < .001) were less likely to be frail. In a multivariate model, frailty was associated with age, self-rated physical health, depression, ability to perform activities of daily living, and mobility (p < .05). CONCLUSION: The findings highlight the importance of incorporating geriatric assessment into cancer survivorship to prevent and delay the progression of frailty.

Understanding breast cancer survivors' financial burden and distress after financial assistance.

PURPOSE: Little is known about how breast cancer may impact survivors' financial well-being. This study aims to investigate the financial status, burden, and opinions of breast cancer survivors who received short-term financial assistance, emotional support, and resource navigation from a community organization during treatment. METHODS: Clients previously served by the community organization were mailed a 16-question survey (n = 751) to elicit their perspective on financial status and burden before, during, and after diagnosis and treatment along with general demographic and opinion items. RESULTS: 136 surveys (18.1%) were returned yielding 118 (15.7%) suitable for analyses. Clients' average age was 54.3 years. Most were female (99.2%), Caucasian (66.1%), and diagnosed with Stage 1 or 2 breast cancer (58.5%). Clients reported significantly worse (p < 0.001) financial status after being diagnosed compared to before diagnosis. Financial distress was highest during cancer treatment (mean = 3.92, SD = 0.85), lowest prior to treatment (mean = 2.48, SD = 1.05), and remained high after treatment (mean = 3.59, SD = 1.05). Those with higher distress after treatment were significantly (p = 0.01) more likely to report lower social support during treatment. CONCLUSIONS: Breast cancer survivors reported worsening financial status and distress after being diagnosed and during treatment despite receiving short-term financial assistance, emotional support, and resource navigation. Survivors' financial distress after treatment remained higher than before treatment. However, most felt receiving financial assistance improved their quality of life and made them feel more in control of financial decision-making. Breast cancer survivors who feel they have low social support during treatment may feel higher financial distress posttreatment.

Screening for cognitive impairment in older adults with hematological malignancies using the Montreal Cognitive Assessment and neuropsychological testing.

OBJECTIVES: The primary objective of the current study is to describe the prevalence and profile of cognitive domains affected in older adults with hematological malignancies evaluated for hematopoietic cell transplantation (HCT) using the Montreal Cognitive Assessment (MoCA) and neuropsychological tests. The secondary objective is to determine if a specific MoCA cut-off score would correlate with the identification of cognitive impairment detected by neuropsychological tests. This would facilitate interpretation of cognitive screening and referral of patients who would likely need further neuropsychological testing. MATERIALS AND METHODS: Fifty-one patients 60 years and older who were evaluated for HCT were assessed using a battery of standardized neuropsychological tests and MoCA. We analyzed Receiver Operating Characteristics (ROC) comparing MoCA scores and four different neuropsychological test criteria for cognitive impairment. RESULTS: The prevalence of cognitive impairment detected by neuropsychological tests was 53 to 70.6% using the criteria for patients with cancer by the International Cancer Cognition Task Force (ICCTF). The following cognitive domains were most affected: language, learning and memory, visuospatial skills, and executive function. MoCA is an appropriate screening test for cognitive impairment. Using the ICCTF criteria, 86 to 100% of patients are correctly classified as having significant cognitive impairment on neuropsychological tests using a cut-off score of 20 or less. CONCLUSION: There is a high prevalence of cognitive impairment identified by neuropsychological tests in older patients with hematological malignancies evaluated for HCT. Identification of an appropriate MoCA cut-off score in this population is important to identify patients who would benefit from further assessment.

Returning to life activities after hematopoietic cell transplantation in older adults.

OBJECTIVES: The prevalence of hematopoietic cell transplant (HCT) among older adults with hematological malignancies has more than doubled over the last decade and continues to grow. HCT is an intense process that can impact functional status and health-related quality of life. The objective of this paper is to describe the experience of returning to life activities after HCT in patients 60 years of age and older and the resources required to adapt and cope to limitations in physical, psychological, and cognitive function. MATERIALS AND METHODS: Twenty English speaking adults 60 years and older with hematological malignancy 3 to 12 months post-HCT completed semi-structured interviews. Open-ended questions and probes were guided by the Transactional Model of Stress and Coping to explore adaptive functioning, coping resources, and coping strategies. An integrated grounded theory approach was used to code the textual data to identify themes. The study took place at a tertiary comprehensive cancer center in the Midwest United States. RESULTS: Eight allogeneic and twelve autologous HCT recipients participated in the interviews. Nineteen participants were within 6-12 months and 1 participant was at 3 months post-HCT. Our findings identify the significant role of engaging in life activities and social support in the recovery of physical, psychological and cognitive function. CONCLUSION: Older HCT recipients are an understudied population. They are at high risk for functional decline. Our findings may provide community oncologists and primary care physicians with a context for providing care to older HCT survivors during their recovery.

Motivating Older Adults with Cancer to Keep Moving: the Implications of Lifestyle Interventions on Physical Activity.

PURPOSE OF REVIEW: The purposes of this review are to describe the unique needs and preferences of older adults with cancer regarding physical activity and to outline the essential characteristics associated with increased physical activity resulting from lifestyle interventions in older adults. RECENT FINDINGS: Functional decline is accelerated in inactive and sedentary older adults. Even a modest increase in physical activity can improve physical function for older cancer survivors. Participation in physical activity is influenced by diverse individual-level factors, behavioral characteristics and skills and social and environmental factors. Thus, programs that are tailored to older adults' preferences provide social support and remove obstacles to participation may be more effective, particularly for older adults with low physical activity and sedentary lifestyle.