Applying a Life Course Biological Age Framework to Improving the Care of Individuals With Adult Cancers

Mandelblatt, Jeanne S.; Ahles, Tim A.; Lippman, Marc E.; Isaacs, Claudine; Adams‐Campbell, Lucile L.; Saykin, Andrew J.; Cohen, Harvey Jay; Carroll, Judith

doi:10.1001/jamaoncol.2021.1160

Cited by 30 publications

(46 citation statements)

References 87 publications

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“…After matching, although age was not an independent prognostic factor in the multivariate Cox regression analysis, further survival analysis showed that patients in the old group had poorer OS when compared with the young group. While previous researchers hold the view that worse survival outcome in the elderly owed to low proportion of receiving adjuvant chemotherapy and poor preoperative nutritional status, we believed the survival disadvantage may be attribute to biological aging, which could lead to vulnerability to cancer and increase risk of cancer death ( 25 ). However, additional studies will be needed to investigate the prognostic effect of biological age in oncology research.…”

Section: Discussionmentioning

confidence: 92%

Prognostic Effect of Age in Resected Pancreatic Cancer Patients: A Propensity Score Matching Analysis

Zhang

Han

et al. 2022

Front. Oncol.

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BackgroundWhile the elderly population account for an indispensable proportion in pancreatic ductal adenocarcinoma (PDAC), these patients are underrepresented in clinical trials. Whether surgery offered the same benefit for elderly patients as that for younger cohort and which factors affected long-term outcome of elderly population remained unclear.AimsThis study aims to evaluate long-term prognosis of elderly PDAC patients (≥70 years old) after surgery and to investigate potential prognostic factors.MethodsThis retrospective study included PDAC patients receiving radical resection from January 2012 to July 2019 in Zhongshan Hospital Fudan University. Patients were divided into young (<70) and old groups (≥70). Propensity score matching (PSM) was conducted to eliminate the confounding factors. We investigated potential prognostic factors via Cox proportional hazards model and Kaplan–Meier estimator. Nomogram model and forest plot were constructed to illustrate the prognostic value of age.ResultsA total of 552 PDAC patients who received radical resection were included in this research. Elderly patients showed poorer nutritional status and were less likely to received adjuvant treatment. After matching, although age [hazard ratio (HR)=1.025, 95%CI 0.997–1.054; p=0.083] was not statistically significant in the multivariate cox regression analysis, further survival analysis showed that patients in the old group had poorer overall survival (OS) when compared with young group (p=0.039). Furthermore, reception of adjuvant chemotherapy (HR=0.411, 95%CI 0.201-0.837; p=0.014) was the only independent prognostic factor among elderly patients and could significantly improve OS. Subgroup analysis indicated that age had better prognostic value in PDAC patients with good preoperative nutritional status and relative low tumor burden. Finally, a prognostic prediction model contained age, reception of adjuvant chemotherapy, American Joint Committee on Cancer (AJCC) 8th T and N stage was constructed and presented in nomogram, whose Harrell’s concordance index was 0.7478 (95%CI, 0.6960–0.7996). The calibration curves at 1 and 3 years indicated an optimal conformity between actual and nomogram-predicted survival probability in the PDAC patient who received surgery.ConclusionThe elderly PDAC patients were associated with worse OS survival after radical resection, and the noticeable negative effect of age was observed among PDAC patients with better preoperative nutritional status and less aggressive tumor biology. Adjuvant chemotherapy was essential to improve survival outcome of elderly PDAC patients following radical resection.

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Section: Discussionmentioning

confidence: 92%

Prognostic Effect of Age in Resected Pancreatic Cancer Patients: A Propensity Score Matching Analysis

Zhang

Han

et al. 2022

Front. Oncol.

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“…Muscle loss occurs to varying degrees across stages and types of disease, body weight or weight stability/ change, and leads to detrimental clinical outcomes, including lower tolerance to treatment and decreased survival [20e23,26]. In fact, low muscle mass is emerging as a clinical marker of biological age, the latter of which has been proposed as an important consideration when prescribing anti-cancer therapies [27].…”

Section: Introductionmentioning

confidence: 99%

The importance of protein sources to support muscle anabolism in cancer: An expert group opinion

et al. 2022

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This opinion paper presents a short review of the potential impact of protein on muscle anabolism in cancer, which is associated with better patient outcomes. Protein source is a topic of interest for patients and clinicians, partly due to recent emphasis on the supposed non-beneficial effect of proteins; therefore, misconceptions involving animal-based (e.g., meat, fish, dairy) and plant-based (e.g., legumes) proteins in cancer are acknowledged and addressed. Although the optimal dietary amino acid composition to support muscle health in cancer is yet to be established, animal-based proteins have a composition that offers superior anabolic potential, compared to plant-derived proteins. Thus, animal-based foods should represent the majority (i.e., !65%) of protein intake during active cancer treatment. A diet rich in plantderived proteins may support muscle anabolism in cancer, albeit requiring a larger quantity of protein to fulfill the optimal amino acid intake. We caution that translating dietary recommendations for cancer prevention to cancer treatment may be inadequate to support the pro-inflammatory and catabolic nature of the disease. We further caution against initiating an exclusively plant-based (i.e., vegan) diet upon a diagnosis of cancer, given the presence of elevated protein requirements and risk of inadequate protein intake to support muscle anabolism. Amino acid combination and the long-term sustainability of a dietary pattern void of animal-based foods requires careful and laborious management of protein intake for patients with cancer. Ultimately, a dietary amino acid composition that promotes muscle anabolism is optimally obtained through combination of animal-and plant-based protein sources.

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“…[10][11][12] However, considerable variability exists in this trajectory of risk suggesting individual differences, or host factors, occurring possibly before cancer diagnosis exist that contribute to vulnerability in accelerated aging after cancer treatments. 12,13 Depression and its history are known host risk factors that may increase vulnerability to health declines, indicating biological aging, especially in cancer survivors. The prevalence of major depressive disorder (MDD) in cancer survivors is high, particularly in breast cancer survivors, with a prevalence nearly 4 times higher than women without a cancer history.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, cancer survivors have a lower life expectancy because of recurrence or adjuvant treatment toxicities (chemotherapy, radiation) 6–9 . Together, these studies suggest that cancer and its treatments may accelerate the aging process, thereby increasing the risk of secondary health issues 10–12 . However, considerable variability exists in this trajectory of risk suggesting individual differences, or host factors, occurring possibly before cancer diagnosis exist that contribute to vulnerability in accelerated aging after cancer treatments 12,13 …”

Section: Introductionmentioning

confidence: 99%

Accelerated mononuclear cell telomere attrition in breast cancer survivors with depression history: A 2‐year longitudinal cohort study

Carroll

Olmstead

Haque

et al. 2022

Cancer

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BACKGROUND: Cancer treatments are thought to accelerate biological aging, although this trajectory is highly variable. Depression is more prevalent in breast cancer survivors and is thought to be a vulnerability factor for biological aging. A lifetime history of depression and cumulative lifetime number of depression episodes could hypothetically be associated with an accelerated rate of biological aging as indexed by attrition of telomere length in a prospective cohort of breast cancer survivors who were not currently depressed. METHODS: Breast cancer survivors (n = 206) without current depression were recruited from a large community-based health plan and were assessed for depression history by a structured diagnostic interview. Blood specimens were provided at baseline and every 8 months over 24 months to measure peripheral blood mononuclear cell (PBMC) telomere length. Mixed linear models examined associations of depression history and number of depression episodes with change in telomere length, adjusting for demographic, comorbidity, and cancer-specific factors. RESULTS: In the fully adjusted model, depression history predicted attrition of PBMC telomere length over 24 months (Beta [SE] = −.006 [.002], p = .001). Greater number of depressive episodes over the lifetime was also associated with accelerated attrition of PBMC telomere length over 24 months (Beta [SE] = −.004 [.001], p = .001). CONCLUSIONS: In breast cancer survivors without current depression, telomere attrition over 24 months was greatest in those with a lifetime depression history, particularly those with the greatest number of episodes of major depressive disorder over their lifetime. Depression history and its cumulative burden may contribute to accelerated biological aging, with implications for risk of morbidity and mortality in breast cancer survivors. Cancer 2022;128:3109-3119.

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Applying a Life Course Biological Age Framework to Improving the Care of Individuals With Adult Cancers

Abstract: Research on the basic mechanisms of aging and cancer will enhance our understanding of both subjects and will enable the development of new strategies for cancer prevention and treatment, as well as the optimal delivery of cancer interventions based on a person's age.

Cited by 30 publications

References 87 publications

Prognostic Effect of Age in Resected Pancreatic Cancer Patients: A Propensity Score Matching Analysis

Prognostic Effect of Age in Resected Pancreatic Cancer Patients: A Propensity Score Matching Analysis

The importance of protein sources to support muscle anabolism in cancer: An expert group opinion

Accelerated mononuclear cell telomere attrition in breast cancer survivors with depression history: A 2‐year longitudinal cohort study

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