One-year mortality and varying ascertainment windows for a Medicare claims-based proxy for frailty in women with stage I-III breast cancer.

Authors

Emilie Duchesneau

Emilie Danielle Duchesneau

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC

Emilie Danielle Duchesneau, Til Sturmer, Dae Hyun Kim, Michele Jonsson Funk, Charles Poole, Alan C Kinlaw, Keturah R Faurot, Qoua L Her, Tiansheng Wang, Jennifer Leigh Lund

Organizations

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, Hebrew SeniorLife Institute for Aging Research, Boston, MA, Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC, Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, NC

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health.

Background: Frail cancer patients are more likely to die or experience treatment toxicity than non-frail patients. The Faurot frailty index (FFI) is a validated Medicare claims-based proxy that predicts frailty in individuals. Frailty is dynamic and can change over time. We assessed the distribution of the FFI and associations with 1-year mortality using varying durations of frailty ascertainment windows in breast cancer patients. Methods: We identified women (66+ yrs) with stage I-III breast cancer in the SEER-Medicare database who had ≥1 year of continuous enrollment in Medicare Parts A and B prior to diagnosis. The FFI-predicted probability of frailty was assessed using demographic and diagnostic and procedural billing information during varying pre-diagnosis ascertainment windows: 3, 6, 8, or 12 months or using all available pre-diagnosis claims. We described the distributions of the claims-based frailty measures using each of the five ascertainment windows and reported 1-year mortality for individuals with high (≥0.20), medium (0.05 - < 0.20), or low (< 0.05) claims-based frailty using Kaplan-Meier analysis. Follow-up began on the date of cancer diagnosis. Results: We identified 235,145 women with breast cancer. Using a 3-month ascertainment window, 76%, 20%, and 4% were classified as having low, medium, and high claims-based frailty. Although the distributions of claims-based frailty were similar using 3, 6, 8, and 12-month frailty ascertainment windows, the use of all available lookback led a wider interquartile range (IQR) for claims-based frailty (Table). Overall, 4% of women died within 1 year of diagnosis. Higher claims-based frailty was strongly associated with increased 1-year mortality risk, using each ascertainment window. Mortality associations were strongest with a 3-month ascertainment window: risk difference (RD) high vs. low frailty 20% (95% CI, 19-20%). Associations were weakest with an all available lookback window: RD high vs. low frailty 11% (95% CI, 11-12%). Conclusions: Varying frailty ascertainment window durations did not lead to substantial differences in the distribution of the FFI in women with stage I-III breast cancer. Associations between the FFI and 1-year mortality monotonically decreased with increasing ascertainment window durations. This may be due to claims in the distant past having less etiological relevance for predicting mortality during the year following cancer diagnosis.

Frailty ascertainment window (months)
Median FFI (IQR)
1-year mortality risk (%)

Low frailty
1-year mortality risk (%)

Medium frailty
1-year mortality risk (%)

High frailty
RD (95% CI)

Medium vs. low
RD (95% CI)

High vs. low
3
0.03 (0.02-0.05)
2
8
22
6 (6-6)
20 (19-20)
6
0.03 (0.02-0.05)
2
7
19
5 (5-6)
18 (17-18)
8
0.03 (0.02-0.05)
2
7
19
5 (5-5)
17 (16-18)
12
0.03 (0.02-0.06)
2
7
18
5 (4-5)
16 (15-17)
All lookback
0.03 (0.02-0.10)
2
5
13
3 (3-3)
11 (11-12)

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Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Palliative and Supportive Care,Technology and Innovation in Quality of Care,Quality, Safety, and Implementation Science

Sub Track

Real-World Evidence

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 396)

DOI

10.1200/JCO.2022.40.28_suppl.396

Abstract #

396

Poster Bd #

E35

Abstract Disclosures

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