Impact of chemotherapy on medium-term physical function and activity of older breast cancer survivors, and associated biomarkers

Abstract

Background Chemotherapy is less often prescribed in older individuals due to concerns about post-treatment morbidity and quality of life. We evaluated the physical performance of breast cancer survivors treated with and without adjuvant chemotherapy. Methods We conducted a case-control study in 56 estrogen receptor positive breast cancer survivors (BCS) on adjuvant aromatase inhibitors 1-2 years after definitive surgery. Cases had received adjuvant chemotherapy (n = 27; age 70.5±3.6 yrs) versus age-matched controls who had not (n = 29; age 70.0±4.3 yrs). Measures of grip strength, physical activity and performance, walking speed, fatigue, and self-reported physical function were collected. Biological correlates of inflammation, frailty and markers of DNA and RNA oxidation were compared. Results Grip strength (Controls: 21±7.4 vs. Cases: 29.7±5.0 kg, p=0.20), physical activity (5403±3204 vs. 6801±9320 steps/day, p=0.45), physical performance (Short Physical Performance Battery score: 10.1±1.8 vs. 10.4±1.1, p=0.52), long-distance walking speed (1.2±0.21 vs. 1.3±0.41 m/sec, p=0.17) were similar between the two groups. Self-reported physical function was marginally lower in cases than controls (Controls: 72±24 vs. Cases: 57±34 AU, p=0.07). Fatigue disruptiveness was not different between groups (Controls: 11.1±13.0 vs. Cases: 15.7±16.2 AUs, p=0.24). Similarly, the inflammation, oxidation, and frailty markers did not present a significant difference between groups, except for vitamin D levels (p=0.04). Conclusion Older women who received chemotherapy reported having slightly lower physical function, but a similar physical performance compared to women who did not. These data suggest that older BCS treated with chemotherapy recover to an extent similar to survivors who only received hormonal therapy.

Gait and Balance Impairments in Breast Cancer Survivors: A Systematic Review and Meta-analysis of Observational Studies

“… 33 , 34 The remaining 29 articles were included in the review. 11 , 12 , 14 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59

Fig 1 Study selection flow chart of studies in the systematic review and meta-analysis.

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“…Fifteen studies were conducted in the United States, 11 , 12 , 14 , 36 , 37 , 39 , 41 , 44 , 45 , 46 , 47 , 48 , 50 , 57 , 60 2 in Finland, 40 , 43 and 2 in Turkey. 35 , 51 For study design, 11 studies were cross-sectional, 35 , 37 , 38 , 40 , 42 , 43 , 45 , 47 , 48 , 49 , 52 11 were RCTs, 14 , 39 , 44 , 46 , 50 , 51 , 54 , 55 , 57 , 58 , 59 and 3 were pre-post. 11 , 36 , 60 Six studies included a control group who had never had breast cancer.…”

“… 11 , 36 , 60 Six studies included a control group who had never had breast cancer. 35 , 38 , 42 , 45 , 47 , 52 Seventeen of the studies measured gait and/or balance as the primary outcome, 11 , 12 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 44 , 45 , 46 , 48 , 49 , 51 , 53 , 58 while 12 analyzed gait and/or balance as secondary outcomes. 14 , 39 , 43 , 47 , 50 , 52 , 54 , 55 , 56 , 57 , 59 , 60 The total sample size was 2025 BCSs and 138 persons who never had breast cancer.…”

Effects of a physical activity programme to prevent physical performance decline in onco‐geriatric patients: a randomized multicentre trial

“…Compared with other older adults, they are at greater risk of other cancers, cardiovascular disease, osteoporosis, diabetes, and accelerated functional decline . However, most survivorship studies have focused on childhood cancer or cancer in young adults but not in older adults …”

“…4 However, most survivorship studies have focused on childhood cancer or cancer in young adults but not in older adults. 5 The long-term outcome of successfully treated cancer patients is relatively unknown except for their vital prognosis. 6,7 Furthermore, the functional consequences of cancer may be greater in elderly than in younger adults.…”