Psychological resilience is associated with increased heterogeneity in the clinical aging phenotypes of patients with cancer.

INTRODUCTION Cancer and its treatments are associated with accelerated aging. Emerging evidence suggests that patients' self-reports of symptoms, functional status, and resilience can identify clinical aging phenotypes. The purpose was to identify distinct clinical aging phenotypes using: six (evening fatigue, sleep disturbance, depression, state anxiety, cognitive function, physical function); seven (addition of pain); and eight (addition of resilience) clinical indicators and evaluate for differences in patient characteristics and quality of life (QOL) outcomes among the phenotypes.

Materials And Methods

Outpatients (n = 1340) completed questionnaires prior to their second or third cycle of chemotherapy. Three separate latent variable models using six, seven, and eight clinical indicators were created. Differences among phenotypes in demographic and clinical characteristics and QOL outcomes were evaluated using parametric and non-parametric tests. Determination of clinically meaningful differences in QOL scores was done using Cohen's d.

Results

For the six and seven indicator models, two and three distinct phenotypes were identified, respectively. For the eight indicator model, five distinct phenotypes were identified: Very Low (32.6%), Low (32.2%), Moderate (16.4%), High (13.2%), and Very High (5.6%) clinical age. Being female, younger, having a higher comorbidity burden, and lower functional status were associated with the worst clinical aging profiles. QOL scores decreased in a stepwise fashion and differences were clinically meaningful.

Discussion

Inclusion of a measure of psychological resilience in the model allows for better discrimination of inter-individual variability in clinical aging phenotypes of oncology outpatients. This approach may assist with identification of patients at increased risk for accelerated aging.