Risk of frailty at an early age higher in adult survivors of childhood cancer

Young adults who survived childhood cancer are more likely than their peers to be frail, according to a study. Also, the condition is more common among female survivors than women decades older.

Researchers also found that frail health was associated with a greater risk for adult childhood cancer survivors of death and chronic disease. Frailty was defined as the presence of at least three of the following: weakness, self-reported exhaustion, physical inactivity, low muscle mass and slow walking speed. In the general population, it is most commonly associated with advancing age. The research appeared in the Journal of Clinical Oncology (2013; doi:10.1200/JCO.2013.52.2268).

In this study of 1,922 childhood cancer survivors, 13.1% of women and 2.7% of men qualified as frail despite an average age of younger than 34 years. In a comparison group of 341 young adults with an average age of 29 years and no history of childhood cancer, none qualified as frail. Nationally, an estimated 9.6% of women 65 years and older and 5.2% of men in the same age group meet the definition. The unexpectedly high prevalence of frailty among childhood cancer survivors suggests accelerated aging, researchers said.

After adjusting for existing chronic health problems, researchers calculated that frail childhood cancer survivors were 2.6 times more likely to die than their nonfrail counterparts. The risk was highest for frail male survivors, who were at a six-fold increased risk of death compared to male survivors who were not frail. Frail survivors were also more than twice as likely as survivors who were not frail to develop additional chronic health problems.

"There are steps survivors can take to reduce their risk and improve their fitness," said the study's first and corresponding author Kirsten Ness, PhD, an associate member of the St. Jude Children's Hospital Department of Epidemiology and Cancer Control, in Memphis, Tennessee. Exercise can reverse frailty in the elderly, and Ness said this study reinforces the need for survivors to work with their health care providers to become more fit.

These results are just the latest findings from the St. Jude Lifetime Cohort Study (St. Jude LIFE). St. Jude LIFE brings the hospital's pediatric cancer survivors back to campus for 2 to 3 days of medical testing and assessments. The goal is to better understand and address the challenges facing childhood cancer survivors as they age.

The survivors in this study were treated at St. Jude between 1962 and 2003. At least 10 years had passed since their cancer diagnosis when they joined St. Jude LIFE.

Frailty was more common among male survivors who smoked, were underweight, and whose pediatric cancer treatment included abdominal or pelvic irradiation. In contrast, lifestyle was not associated with frailty risk in female survivors. Cranial irradiation was associated with a greater likelihood of frailty in men and women.

The researchers are now studying how frailty in childhood cancer survivors differs from age-related frailty.

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