Comparing frailty and health outcomes in AYA cancer survivors to propensity-matched non-cancer controls: A secondary analysis of NHANES data.

Abstract

652 Background: Adolescent and young adult (AYA) cancer survivors demonstrate high survival rates; however, many experience late and long-term effects of cancer and cancer treatment. Frailty provides a comprehensive framework for describing cancer-related health decline in this high-risk population. This study examined whether frailty and related health-outcomes (i.e., comorbidity count, self-reported health status, and occupational limitations) differed between AYA survivors and propensity-matched non-cancer controls. Methods: This was a cross-sectional, secondary analysis of data collected from AYA cancer survivors, diagnosed between 15-39 years of age who participated in NHANES (1999-2018), a U.S. health survey. All cancer types, except non-melanoma skin cancers, were included. A 37-item frailty index was constructed (score range: 0–1; categories: robust <0.20, pre-frail 0.20–0.35, frail >0.35). Nearest neighbor propensity score matching (1:5) was conducted. Health outcomes (health status [categorical], comorbidities [count], and occupational limitations [yes/no]) were assessed via self-report. Differences between AYA survivors and matched non-cancer controls were assessed via survey-weighted regression, adjusting for age, sex, race/ethnicity, poverty income ratio, and education. Results: AYA survivors (n=723) and matched controls (n=3,615) were identified. Compared to matched controls, AYA survivors had higher continuous frailty scores (Beta=+0.05, p<0.001) and 89% higher odds of worse frailty category (p<0.001). AYA survivors had 46% more comorbidities (p<0.001), 84% higher odds of worse self-reported health (p<0.001), and 95% higher odds of occupational limitations (p<0.001). Lower poverty income ratio was the strongest predictor of frailty and poorer health outcomes for all variables. Conclusions: AYA cancer survivors demonstrated worse frailty and health outcomes when compared to non-cancer controls. Frailty indices may capture cancer-related health decline and may serve as a clinically actionable tool to identify survivors at risk of poor outcomes. The strong influence of socioeconomic factors highlights the unique long-term implications of life stage interruptions that AYAs face during and after receiving a cancer diagnosis. Further investigation of these health outcomes and their biological and social underpinnings in AYA survivors is necessary to support the development of tailored survivorship care.