Frailty and sarcopenia within the earliest national Dutch childhood cancer survivor cohort (DCCSS-LATER) : a cross-sectional study

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved..

BACKGROUND: Childhood cancer survivors appear to be at increased risk of frailty and sarcopenia, but evidence on the occurrence of and high-risk groups for these aging phenotypes is scarce, especially in European survivors. The aim of this cross-sectional study was to assess the prevalence of and explore risk factors for pre-frailty, frailty, and sarcopenia in a national cohort of Dutch childhood cancer survivors diagnosed between 1963 and 2001.

METHODS: Eligible individuals (alive at the time of study, living in the Netherlands, age 18-45 years, and had not previously declined to participate in a late-effects study) from the Dutch Childhood Cancer Survivor Study (DCCSS-LATER) cohort were invited to take part in this cross-sectional study. We defined pre-frailty and frailty according to modified Fried criteria, and sarcopenia according to the European Working Group on Sarcopenia in Older People 2 definition. Associations between these conditions and demographic and treatment-related as well as endocrine and lifestyle-related factors were estimated with two separate multivariable logistic regression models in survivors with any frailty measurement or complete sarcopenia measurements.

FINDINGS: 3996 adult survivors of the DCCSS-LATER cohort were invited to participate in this cross-sectional study. 1993 non-participants were excluded due to lack of response or a decline to participate and 2003 (50·1%) childhood cancer survivors aged 18-45 years were included. 1114 (55·6%) participants had complete frailty measurements and 1472 (73·5%) participants had complete sarcopenia measurements. Mean age at participation was 33·1 years (SD  7·2). 1037 (51·8%) participants were male, 966 (48·2%) were female, and none were transgender. In survivors with complete frailty measurements or complete sarcopenia measurements, the percentage of pre-frailty was 20·3% (95% CI 18·0-22·7), frailty was 7·4% (6·0-9·0), and sarcopenia was 4·4% (3·5-5·6). In the models for pre-frailty, underweight (odds ratio [OR] 3·38 [95% CI 1·92-5·95]) and obesity (OR 1·67 [1·14-2·43]), cranial irradiation (OR 2·07 [1·47-2·93]), total body irradiation (OR 3·17 [1·77-5·70]), cisplatin dose of at least 600 mg/m2 (OR 3·75 [1·82-7·74]), growth hormone deficiency (OR 2·25 [1·23-4·09]), hyperthyroidism (OR 3·72 [1·63-8·47]), bone mineral density (Z score ≤-1 and >-2, OR 1·80 [95% CI 1·31-2·47]; Z score ≤-2, OR 3·37 [2·20-5·15]), and folic acid deficiency (OR 1·87 [1·31-2·68]) were considered significant. For frailty, associated factors included age at diagnosis between 10-18 years (OR 1·94 [95% CI 1·19-3·16]), underweight (OR 3·09 [1·42-6·69]), cranial irradiation (OR 2·65 [1·59-4·34]), total body irradiation (OR 3·28 [1·48-7·28]), cisplatin dose of at least 600 mg/m2 (OR 3·93 [1·45-10·67]), higher carboplatin doses (per g/m2; OR 1·15 [1·02-1·31]), cyclophosphamide equivalent dose of at least 20 g/m2 (OR 3·90 [1·65-9·24]), hyperthyroidism (OR 2·87 [1·06-7·76]), bone mineral density Z score ≤-2 (OR 2·85 [1·54-5·29]), and folic acid deficiency (OR 2·04 [1·20-3·46]). Male sex (OR 4·56 [95%CI 2·26-9·17]), lower BMI (continuous, OR 0·52 [0·45-0·60]), cranial irradiation (OR 3·87 [1·80-8·31]), total body irradiation (OR 4·52 [1·67-12·20]), hypogonadism (OR 3·96 [1·40-11·18]), growth hormone deficiency (OR 4·66 [1·44-15·15]), and vitamin B12 deficiency (OR 6·26 [2·17-1·81]) were significantly associated with sarcopenia.

INTERPRETATION: Our findings show that frailty and sarcopenia occur already at a mean age of 33 years in childhood cancer survivors. Early recognition and interventions for endocrine disorders and dietary deficiencies could be important in minimising the risk of pre-frailty, frailty, and sarcopenia in this population.

FUNDING: Children Cancer-free Foundation, KiKaRoW, Dutch Cancer Society, ODAS Foundation.

Medienart:	E-Artikel

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Zur Gesamtaufnahme - volume:4
Enthalten in:	The lancet. Healthy longevity - 4(2023), 4 vom: 24. Apr., Seite e155-e165

Sprache:	Englisch

Beteiligte Personen:

van Atteveld, Jenneke E [VerfasserIn] de Winter, Demi T C [VerfasserIn] Pluimakers, Vincent G [VerfasserIn] Fiocco, Marta [VerfasserIn] Nievelstein, Rutger A J [VerfasserIn] Hobbelink, Monique G G [VerfasserIn] Kremer, Leontien C M [VerfasserIn] Grootenhuis, Martha A [VerfasserIn] Maurice-Stam, Heleen [VerfasserIn] Tissing, Wim J E [VerfasserIn] de Vries, Andrica C H [VerfasserIn] Loonen, Jacqueline J [VerfasserIn] van Dulmen-den Broeder, Eline [VerfasserIn] van der Pal, Helena J H [VerfasserIn] Pluijm, Saskia M F [VerfasserIn] van der Heiden-van der Loo, Margriet [VerfasserIn] Versluijs, A Birgitta [VerfasserIn] Louwerens, Marloes [VerfasserIn] Bresters, Dorine [VerfasserIn] van Santen, Hanneke M [VerfasserIn] Hoefer, Imo [VerfasserIn] van den Berg, Sjoerd A A [VerfasserIn] den Hartogh, Jaap [VerfasserIn] Hoeijmakers, Jan H J [VerfasserIn] Neggers, Sebastian J C M M [VerfasserIn] van den Heuvel-Eibrink, Marry M [VerfasserIn] Dutch LATER study group [VerfasserIn]

Links:	Volltext

Themen:	9002-72-6 Cisplatin Growth Hormone Journal Article Q20Q21Q62J Research Support, Non-U.S. Gov't

Anmerkungen:	Date Completed 04.04.2023 Date Revised 13.04.2023 published: Print Citation Status MEDLINE

doi:	10.1016/S2666-7568(23)00020-X

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	NLM355081342