Study Links Frailty to Five-Year Mortality Rate Among Older Women with Breast Cancer

A new study links changes in frailty, a measure of decreased physiological capacity that leads to fatigue, slow walking, muscle weakness, physical inactivity, and weight loss, to five-year survival rates in older women with breast cancer. These findings suggest that managing frailty during chemotherapy could improve outcomes.

Published in JAMA Network Open and entitled “Frailty Trajectories Following Adjuvant Chemotherapy and Mortality in Older Women With Breast Cancer,” the study found that 4.5% of women out of a cohort of 20,292 women aged 65 and older with stage I to stage III breast cancer experienced nonresilient frailty trajectories — a decline in physiologic reserve — following chemotherapy initiation. These women had significantly worse survival outcomes compared to those with more stable or improving frailty trajectories. Despite representing a small percentage of the cohort, the group of nonresilient women had notably higher mortality rates.

The study also found that those who maintained their strength or recovered from a temporary decline had better survival rates. However, while tracking frailty changes over time helped researchers understand overall survival trends in groups of patients, it was less useful for predicting an individual’s risk of death.

The study also highlighted the need for further research on whether frailty changes can predict other important health outcomes, like falls or hospitalizations. It suggested that patients at higher risk — such as those with preexisting health conditions — might benefit from targeted interventions like nutrition support, physical activity, and better management of treatment side effects. Researchers emphasized the importance of tracking frailty throughout cancer treatment to improve care and outcomes for older patients.

“Our research demonstrates that frailty is not a static condition but can change over time, especially during cancer treatment. By closely monitoring frailty trajectories, health care providers can better identify patients at increased risk and implement timely interventions to improve survival outcomes,” said Dae Hyun Kim, MD, MPH, ScD, associate scientist and founder of the Frailty Research Program at the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife.

In addition to Dr. Kim, researchers included: Emilie D. Duchesneau, PhD, assistant professor, Epidemiology and Prevention, Wake Forest University School of Medicine; Til Stürmer, PhD, MD, MPH, Nancy A. Dreyer, distinguished professor, Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill; Qoua Her, PharmD, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina; Zhang Zhang, PhD, Associate Professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina; Nicholas M. Pajewski, PhD, professor, Biostatistics and Data Science, Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine; Heidi D. Klepin, MD, MS, professor, Hematology and Oncology, Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest University School of Medicine; Kathryn E. Callahan, MD, MS, associate professor, Gerontology and Geriatric Medicine, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine; Jennifer L. Lund, PhD, professor and director of data strategy and education Cancer Information Population Health Resource (CIPHR), Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina.

Funding
Dr. Duchesneau was supported by the Cancer Care Quality Training Program at the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill (grant T32CA116339) at the time of analysis. This work was supported by a National Institute on Aging (NIA) grant R01AG056479 to Dr. Stürmer. Dr. Kim is supported by NIA grant K24AG073527. Dr. Callahan is supported by NIA grant K76AG059986. The database infrastructure used for this project was funded by the CER Strategic Initiative of UNC’s Clinical & Translational Science Award (UL1TR002489), the UNC School of Medicine, and the UNC Lineberger Comprehensive Cancer Center’s University Cancer Research Fund via the State of North Carolina. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; Jack Satter House, Revere; and Leyland Community, Dorchester. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $98 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 500 geriatric care providers each year. For more information about Hebrew SeniorLife, follow us on our blog, Facebook, Instagram, Threads, and LinkedIn.

About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.