INTRODUCTION:Advances in breast cancer treatments have reduced acute toxicities, but there can be lingering side effects that impact quality of life (QoL) and function years after treatment completion. Understanding these long-term sequelae in younger as compared older survivors under a variety of treatment scenarios may facilitate early symptom-moderating interventions. MATERIALS AND METHODS:This is a single-arm observational study of women who are three or more years post primary treatment for early breast cancer (stage I-III). All study participants were recurrence-free and without active malignancies at the time of study recruitment when they completed a variety of patient-reported outcome (PRO) surveys. PROMIS-Global (Patient-Reported Outcomes Measurement Information System) Physical Function and PROMIS-Global Mental Health were the primary outcome variables. RESULTS:The cohort included 122 women under age 65 and 125 women age 65 or older at the time of follow-up. Younger survivors were more likely to have stage II-III disease (p = .05), undergo mastectomy (p < .0001), and receive chemotherapy (p = .0009). Older survivors were more likely to receive radiation (p = .004) and endocrine therapy (p = .02). At follow-up, older survivors reported better mental health (p = .003), less anxiety (p = .007), less stress (p = .002), fewer endocrine symptoms (p ≤0.0001), and higher social/family well-being (p = .03). Older survivors also reported more severe neurotoxicity (p = .002) and worse aging-associated arthralgia (p = .05) compared to the younger women. DISCUSSION:Long-term QoL and function outcomes differ by age for early breast cancer survivors. The findings of this study highlight the need for age-specific monitoring and supportive care strategies to promote long-term quality of life and function in breast cancer survivors of all ages.

INTRODUCTION:Performance status assessments may overlook important health vulnerabilities in adults with cancer. While geriatric assessment (GA) systematically evaluates multiple domains including physical function, cognition, psychological health, comorbidity, and nutrition, it has been predominantly studied in older adults. We evaluated the prevalence and patterns of GA-identified deficits among adults of all ages initiating systemic therapy for lymphoma. MATERIALS AND METHODS:Adults with lymphoma enrolled in a prospective registry at an academic cancer center from 2018 to 2025 completed a modified Cancer and Aging Research Group (CARG) GA at treatment initiation. The assessment included validated measures across eight domains: mobility (Timed Up and Go), falls history, instrumental activities of daily living (IADLs), medication burden, comorbidities, weight loss, cognition (Blessed Orientation-Memory-Concentration test), and psychological health (Mental Health Index-13). Karnofsky Performance Status (KPS) was documented. Prevalence of deficits was compared between adults <65 and ≥ 65 years. RESULTS:Among 97 participants (mean age 57 years, range 22-84; 39% ≥65 years), 94% had normal KPS (≥80). Despite preserved performance status, 56% had multiple (≥2) GA-identified deficits, and only 21% had zero deficits. The most common deficit was unintentional weight loss (43% overall). Among younger adults (<65 years), substantial proportions reported weight loss (34%), falls (27%), IADL impairment (27%), and anxiety or depression (45%). Most deficits did not differ significantly between age groups, though weight loss, multimorbidity (≥4 comorbidities), and severe polypharmacy (≥10 medications) were more prevalent in older adults. DISCUSSION:GA reveals high prevalence of health-related deficits across multiple domains in adults with lymphoma regardless of age, despite preserved performance status. These findings support a shift toward needs-based rather than age-based approaches to identify individuals who may benefit from supportive care interventions.

BACKGROUND:Many patients with breast cancer report cognitive impairment for several years after treatment. The objective of this study was to describe associations between neurobehavioral symptoms experienced during chemotherapy for early-stage breast cancer and patient-reported cancer-related cognitive impairment (CRCI) ≥ 3 years post-chemotherapy. METHODS:This study is a secondary analysis of women with stage I-III breast cancer who had enrolled in clinical trials promoting self-directed walking during chemotherapy and were re-consented for a study focused on quality-of-life outcomes ≥ 3 years post-chemotherapy. Patient-reported CRCI was assessed using the FACT-Cog PCI (cut point for impairment < 54). Multivariable log-binomial regression models, adjusting for age, race, and education, examined associations between long-term CRCI and baseline demographic characteristics, cancer diagnosis and treatment, and patient-reported neurobehavioral symptoms during chemotherapy and at long-term follow-up. RESULTS:Among 104 participants, 39% reported CRCI at long-term follow-up, on average 6 years post-chemotherapy [range: 2.9-8.8]. CRCI was more common among those reporting moderate or worse depressive (RR 1.75, 95% CI 1.11-2.75, p = 0.02), anxiety (RR 1.95, 95% CI 1.22-3.11, p = 0.005), or fatigue (RR 1.92, 95% CI 1.09-3.36, p = 0.02) symptoms during chemotherapy. In sensitivity analyses limited to patients with none or mild symptoms prior to chemotherapy, depressive (RR 2.11, 95% CI 1.23-3.63, p = 0.007) and fatigue (RR 1.81, 95% CI 1.81, 95% CI 1.01-3.24, p = 0.05) symptoms emerging during chemotherapy were also associated with CRCI at follow-up. CONCLUSIONS:Patient-reported neurobehavioral symptoms experienced during chemotherapy, including depression, anxiety, and fatigue, were associated with patient-reported CRCI years after primary treatment and should be monitored for timely intervention opportunities.

ABSTRACT Background p16 INK4a ( p16 ), a robust marker of cell senescence, rises rapidly and dramatically after adjuvant chemotherapy for breast cancer. We measured p16 in peripheral blood T cells of 119 women with stage I–III breast cancer, 75 with previous adjuvant chemotherapy and 44 randomly selected women who had never received chemotherapy. p16 was measured at least 3 years (mean, 6 years) following diagnosis. Aims This study aims to assess the expression of p16 after long‐term follow‐up and define the trajectory of the p16 increase in a subset of patients with baseline, 6‐month post‐chemotherapy, and long‐term follow‐up data. Methods and Results All patients were treated in accordance with national guidelines, and 53% of the chemotherapy‐treated patients received anthracycline regimens. After a mean follow‐up of 6 years from the end of treatment, chemotherapy‐treated patients demonstrated p16 levels corresponding to approximate age‐equivalent increase of ∼14 years compared to 2.1 years in non‐chemotherapy‐treated patients. When compared to community‐dwelling adults, p16 expression increased markedly at 6 months post‐chemotherapy, particularly among anthracycline‐treated patients (corresponding to larger age‐equivalent deviation: median 21.5 years vs. median 15.4 years). At long‐term follow‐up, both anthracycline and non‐anthracycline‐treated patients showed elevated but converging p16 levels (age‐equivalent median of 18.1 years vs. median 17.2 years), indicating an improvement in p16 levels over time in anthracycline‐treated patients. Age‐equivalent values are reported as an interpretive aid derived from population‐level p16 –age relationship and are not intended to represent literal biological age or clock‐based aging. Conclusion Early breast cancer patients treated with chemotherapy exhibited a marked increase in p16 expression shortly after treatment completion that persists for years after treatment. The long‐term impact of these changes remains uncertain but raises the possibility that chemotherapy‐related cellular senescence could contribute to an increased risk of age‐related comorbidities over time.

Background: Age, race, body mass index (BMI), breast density, parity, smoking and alcohol use are associated with increased risk for breast cancer. These factors, as well as tumor characteristics, treatment regimens and comorbidities, are analyzed for associations with five-year event free survival (EFS) in a sample of women with Stage I-III breast cancer who received chemotherapy with curative intent. Methods: EFS was defined in terms of breast cancer recurrence, second primary, metastasis, and overall survival. Analyses were stratified by age (under age 65 vs. over age 65). EFS was estimated using the Kaplan–Meier method and compared using a Cox proportional hazard model. Results: In a sample of 821 women, mean age at diagnosis was 54 years, with 75% White and 22% Black. Younger women had higher proportions of Stage II and III tumors (p = 0.005), larger tumor size (p = 0.0004), and higher breast density (p = 0.003). Five-year EFS was 91% among younger vs. 82% among older women (p = 0.0005). In women aged < 65, there were 48 EFS events, and triple negative patients had significantly worse EFS compared to other subtypes (p = 0.003). Smokers also had worse EFS (p = 0.04). In women aged ≥ 65, there were 26 events, and both tumor size (p = 0.02) and mastectomy (p = 0.03) were significant for EFS. Conclusions: In our sample, triple negative subtype, smoking history, tumor size, and surgery type were significantly associated with shorter EFS. Race, BMI, alcohol use, parity, breast density, radiation treatment, and specific chemotherapy regimen were not significant for EFS in either age group.

As patient-reported symptoms are increasingly incorporated into routine clinical practice and captured in electronic medical records these data can be used to conduct health-related quality of life research studies. This study compares symptom reports from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) and its precursor patient reported symptom monitoring (PRSM) (hereafter PRSM/PRO-CTCAE) with multi-item patient-reported outcome (PRO) scales for fatigue (Functional Assessment of Chronic Illness Therapy/FACIT-Fatigue) and depression and anxiety (Mental Health Index/MHI). This is a secondary analysis of data collected from women with early breast cancer (Stage I-III) scheduled for chemotherapy who completed PRSM/PRO-CTCAE, FACIT-Fatigue, and MHI scales pre- and post-chemotherapy. Spearman correlation coefficients estimated the magnitude and direction of correlations between measures (convergent validity). For each symptom, patients were then categorized based on who improved, stayed the same, or worsened on the composite PRSM/PRO-CTCAE score, and changes in scores on the PRO scales were compared. In a sample of 374 women, mean age was 57 years (SD 12.6) with 76

346 Background: Findings from a comprehensive functional assessment (CA) in a cohort of adults with Hodgkin and non-Hodgkin lymphoma (NHL). Specifically, we evaluate the utility of the CA in identifying functional, cognitive, and other patient-reported characteristics prior to chemotherapy. Methods: Adults aged 18 and older with lymphoma including Hodgkin, aggressive B-cell NHL, indolent B-cell NHL (including CLL/SLL), or T-cell NHL were recruited to a prospective observational cohort study from 2018 through 2025 when starting a new line of therapy for either newly diagnosed or relapsed/refractory lymphoma. Study participants completed a CA based on a modified Cancer and Aging Research Group geriatric assessment (Hurria et al, Cancer 2025; mycarg.org/?page_id=4480). Initial assessments and questionnaires were performed at time of enrollment. Data were analyzed using descriptive statistics for the full cohort and stratified by concurrent Karnofsky performance status (KPS) (score < 80 vs ≥ 80). The domains assessed by CA included number of medications taken daily, number of comorbidities, dependence in instrumental activities of daily living (IADLs), Timed Up & Go (TUG), number of falls in the preceding 6 months, and presence of depression or anxiety via Mental Health Index-13. Results: Among 80 adults, the mean age was 57 years (range 22-84), 24% were aged ≥65 years, and 83% were white. 25% of the cohort had Hodgkin lymphoma, 46% had an aggressive B-cell NHL, 18% indolent B-cell NHL, and the remainder had T-cell NHL. In the full cohort, dependence in ≥1 instrumental activity of daily living was the most common area of impairment, observed in 31%, followed by ≥1 fall in the prior 6 months among 25% of the cohort (Table). The average number of medications and comorbidities per patient was 5 and 1.3, respectively. Although most of the cohort (91%) had a normal performance status (KPS ≥ 80), a majority of the cohort (51%) had multiple impairments identified on the CA, with a plurality (34%) having ≥ 3 impairments. Only 23% of the cohort had zero deficits identified. Conclusions: A modified CARG geriatric assessment demonstrated functional impairments even in patients considered to have a good performance status based on a KPS (≥ 80) and younger patients that would not be typically defined as “geriatric”. Future studies should focus on using CA measures to identify opportunities for targeting relevant supportive care interventions to patients. Considering the relatively young median age observed in this cohort, the current study highlights the potential utility for comprehensive assessment tools derived from the geriatrics literature to identify clinically relevant issues among younger as well as older adults with cancer. Domain Polypharmacy (>10) High Comorbidity (4+) IADL TUG Falls Weight Loss Mental Health Deficit Cognitive Impairment % of cohort 14 8 31 4 25 45 35 10

BACKGROUND:The Institute of Medicine (IOM) recommends that essential aspects of a patient's sociodemographic, psychological, and behavioral characteristics be documented in the electronic health record (EMR). PATIENTS AND METHODS:For this study of women receiving chemotherapy for early breast cancer (Stages I-III), EMR clinician notes were queried with regard to documentation of the patient's current (1) living situation, (2) caregiver responsibilities, and (3) accompaniment during chemotherapy. Descriptive statistics for patient sociodemographic and tumor characteristics, and clinician-reported social circumstances were reported for older and younger patients and compared between two age groups using Fisher's exact tests for categorical variables and t-tests for continuous variables. RESULTS:The sample includes 104 women aged 65 or older (range 65-83; 17% Black) and 250 under age 65 (range 23-64; 22% Black). Mean number of comorbidities was 3.7 (range 0-8) among older patients and 1.7 (range 0-9) among younger patients (P < .0001). There were no significant inter-group differences in breast cancer stage or phenotype. Clinician notes affirmatively documented that the patient was living with someone (70% older/85% younger; P = .002), the patient had caregiver responsibilities (12% older/44% younger; P < .0001) and was accompanied by someone during chemotherapy (79% older/89% younger; P = .02). CONCLUSION:Clinician notes pertaining to younger patients as compared to older patients more often provided affirmative and specific documentation that the patient was living with someone, a caregiver for someone, and accompanied by someone during the chemotherapy infusion visit. These three factors are important to document and monitor in patients of all ages as they can impact treatment experience and quality of life during and after chemotherapy.

Our study compared quality of life (QOL) in women with localized breast cancer receiving chemotherapy with or without radiation therapy. Patient-reported QOL from baseline to post-treatment was noninferior between patients receiving radiation therapy versus those who did not receive radiation therapy. QOL differences in breast cancer patients receiving multimodality therapy helps to understand the impact to patients. Purpose: Understanding quality of life (QOL) implications of individual components of breast cancer treatment is important as systemic therapies continue to improve oncologic outcomes. We hypothesized that adjuvant radiation therapy does not significantly impact QOL domains in breast cancer patients undergoing chemotherapy. Methods: Data was drawn from three prospective studies in women with localized breast cancer being treated with chemotherapy from March 2014 to December 2019. Patient-reported measures were collected at baseline (pretreatment) and post-treatment using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measure, which consists of 5 subscales. Changes in mean QOL scores in patients who received radiotherapy were compared to those who did not using a onesided noninferiority method. Statistical significance was determined below 0.05 to meet noninferiority. Results: In a sample of 175 patients, 131 were treated with radiation and 44 had no radiation. The sample consisted mostly of stage I-II breast cancer (78%) with hormone receptor positive (59%) disease, receiving either neoadjuvant (36%) or adjuvant chemotherapy (64%). Mean change in QOL for the group treated with radiation compared to no radiation was noninferior with respect to Physical Well-Being ( P = .0027), Social/Family Well-Being ( P = .0002), Emotional Well-Being ( P = .0203), FACIT-Fatigue Subscale ( P = .0072), and the Total FACIT-F score ( P = .0005); however, mean change in QOL did not meet noninferiority for Functional Well-Being ( P = .0594). Conclusion: Patient-reported QOL from baseline to post-treatment, using the Total FACIT-F score, was noninferior in patients treated with versus without radiation therapy. This finding, in addition to individualized QOL subscales, provides important information in the informed decision-making process when discussing the effects of locoregional radiation on QOL in localized breast cancer patients treated with chemotherapy.

INTRODUCTION:Geriatric assessment (GA)-guided supportive care programs have been successful in improving treatment outcomes for older adults with solid-organ cancers. This study aimed to evaluate the feasibility of a GA-guided supportive care program among older adults treated for multiple myeloma (MM).MATERIALS AND METHODS:The study utilized an existing registry of adults with plasma cell disorders at the University of North Carolina. Patients with MM, aged 60 or older, and having a GA-identified deficit in one or more problem area were offered referrals to supportive care resources during routine visits. Problem areas included physical function deficits, polypharmacy, and anxiety or depression. Patients with physical function deficits were offered referral to physical therapy (PT), those with polypharmacy to an Oncology Clinical Pharmacist Practitioner (CPP), and those with mental health symptoms to the Comprehensive Cancer Support Program (CCSP).RESULTS:Of the 58 individuals identified as having at least one deficit on the GA, PT was the most commonly identified relevant resource (79%), followed by CPP visits (57%). Among individuals that were offered referral(s) to at least one new supportive care resource, the acceptance rate was 50%. Referral acceptance rates were highest among those recommended for a CPP visit (55% of those approached) and lowest for CCSP (0%).DISCUSSION:The study examined the feasibility and acceptability of a referral program for supportive care resources among older adults with MM who have deficits on GA. The most commonly identified deficit was physical functioning, followed by polypharmacy and mental health. The study found that physical interventions and referrals to CPPs were the most accepted interventions. However, the low proportion of patients who accepted physical therapy referrals indicates the need for tailored and more personalized approaches. Further research is needed to explore the feasibility and impact of supportive care referral programs for older adults with MM.

Background: In a convenience sample of women scheduled for chemotherapy for early-stage breast cancer, we investigated associations of the Center for Disease Control and Prevention's neighborhood-level social vulnerability index (SVI) with pretreatment demographics and patient-reported outcome (PRO) measures (health behavior, function and quality of life, treatment toxicities during chemotherapy). Methods: The SVI Overall score is comprised of 4 themes: socioeconomic, household composition, minority status/language, and household type/transportation, with scores ranging from 0 = lowest to 1 = highest vulnerability neighborhoods. Participant SVI scores were derived from zip codes listed in the patient's address within the electronic medical record (EMR). Associations of study variables with SVI were evaluated using Spearman correlation for continuous variables and Kruskal-Wallis tests for categorical variables. Results: In a sample of 309 women, the mean age was 56 years (range 23-83) and 75% White. Greater vulnerability SVI Overall score was associated with lower education (P =.02), nonmarriage (P <=.0001), higher body mass index (P =.03), and prechemotherapy PRO measures such as fewer self-reported walking minutes/week (P <=.001), history of smoking (P =.02) and alcohol use (P < .001), depression (P =.01), and lower emotional social support (P =.008). During chemotherapy, moderate, severe, or very severe symptoms were associated with greater vulnerability SVI Overall scores for hot flashes (P =.03), arthralgia (P =.02), myalgia (P =.02), peripheral neuropathy (P =.01), edema of limbs (P =.04), and nausea (P <.001). Conclusions: SVI scores derived from addresses in the patient's EMR can be used to generate information that adds to the patient's social history in ways that are informative for anticipating and monitoring chemotherapy-related toxicities.

11047 Background: A 10-item frailty index based on a comprehensive geriatric assessment (FI-CGA-10) is a recently developed measure of frailty in the geriatric oncology setting [Oncologist, 26, e1751 (2021)]. Our objective was to investigate the association between frailty defined by the FI-CGA-10 and health-related quality of life (HRQOL) in older adults with cancer. Methods: This study included 1015 consecutive older adults with cancer who underwent a CGA before cancer treatment decision at a geriatric oncology service in Japan from February 2020 through September 2023. Fitness and frailty level was evaluated using the FI-CGA-10 that assesses 10 domains: cognition, mood, communication, mobility, balance, nutrition, base and instrumental activities of daily living, social support, and comorbidity. Deficits in each domain were scored as 0 (no problem), 0.5 (minor problem), and 1.0 (major problem). FI-CGA-10 scores (range 0-1) were calculated by dividing the sum of the scores for each domain by 10 and then categorized as fit (<0.2), pre-frail (0.2–0.35), and frail (>0.35). HRQOL was measured by the EQ-5D-5L index score and visual analogue scale (VAS) at the CGA consultation. The minimally important difference (MID) values for the EQ-5D-5L Japan-based index and VAS scores are 0.048 and 7, respectively. Associations between EQ-5D-5L and FI-CGA-10 scores were analyzed by Pearson’s correlation and linear regression models adjusting for covariates (age, sex, cancer type, and stage). Results: Median age was 80 years, 60% were male, and 68% had gastrointestinal cancer. The mean +- SD of the FI-CGA-10 score was 0.35 +- 0.19. The FI-CGA-10 negatively correlated with the EQ-5D-5L index (Pearson’s r = -0.69; 95% CI -0.72 to -0.66; P<.001) and VAS (r = -0.47; 95% CI -0.52 to -0.42; P<.001) scores. After adjusting for the covariates, each 0.1 unit increase in FI-CGA-10 score was associated with 0.070 decrease in EQ-5D-5L index (95% CI -0.075 to -0.066; P<.001) and 4.9 decrease in VAS scores (95% CI -5.5 to -4.4; P<.001). Using the three-level classification, 22% of patients (n = 221) were categorized as fit, 38% (n = 384) as pre-frail, and 40% (n =410) as frail. Overall, the fit group had the highest EQ-5D-5L index and VAS scores followed by the pre-frail and frail groups (table). The score differences between the frailty categories were statistically significant and clinically meaningful according to the MID values. Conclusions: This study demonstrated that frailty assessed by the FI-CGA-10 cross-sectionally correlated with HRQOL measured by the EQ-5D-5L in older Japanese adults with cancer. The observed association further supports construct validity of the FI-CGA-10 as a CGA-based frailty measure. [Table: see text]

We developed a self-directed Leg And Walking Self-exercise (LAWS) program informed by the Exercise is Medicine initiative and evaluated the feasibility and acceptability of this program in older adults with cancer. Over a 1-year period, we prospectively enrolled 40 older adults who received a comprehensive geriatric assessment (CGA) at a geriatric oncology service and initiated a new line of systemic therapy for advanced cancer as inpatients. LAWS is a tailored, self-directed exercise program consisting of leg resistance training and walking. Exercise adherence was recorded using an exercise diary to assess feasibility. Patient perspectives on this program were evaluated using the Feasibility of Intervention Measure (FIM) and Acceptability of Intervention Measure (AIM), with a score range of 1–5, higher being better. Overall, 28

Background: There is a need to identify pre-treatment characteristics of women with early breast cancer that are associated with persistent fatigue or suboptimal health-related quality of life (HRQOL) post-chemotherapy as potential targets for pre-habilitation interventions: Patients and Methods: Ancillary analysis of previously collected data from patients with newly diagnosed Stage I-III breast cancer scheduled to receive chemotherapy with curative intent. The objective was to identify baseline (pre-chemotherapy) variables associated with meaningful deteriorations in fatigue and other measures of HRQOL from pre-treatment to 6 months after chemotherapy completion. Percentages are reported along with unadjusted and adjusted relative risks. Results: In a sample of 249 women post-chemotherapy, 32% reported worsening fatigue (FACIT-F), 35% worsening Physical Well-Being (PWB), 16% worsening Functional Well-Being (FWB), 8% worsening Emotional Well-Being (EWB), and 30% worsening Social Well-Being (SWB). In multivariable (MV) analysis, variables that were significant in univariate analysis – Black race, high BMI, and baseline poorer EWB – remained significant for worsening post-chemotherapy fatigue (FACIT-F). In MV analysis that included race, education, falls and baseline EWB, Black race and a positive falls history remained significant for worsening PWB. In MV analysis inclusive of race, SPPB and FWB, lower SPPB and FWB remained significant predictors of worsening FWB. In MV analysis that included baseline Mental Health Index-Anxiety, EWB and SWB, a higher SWB and lower EWB remained significant for worsening SWB. Conclusion: Pre-chemotherapy characteristics in women with early-stage breast cancer that are associated with increased fatigue and reduced HRQOL post-treatment could be used to identify patients who may benefit from pre-habilitation interventions. Citation Format: Lyndsay Cooper, Sasha Knowlton, Kirsten Nyrop, Allison Deal, Coral Aman, Annie Page, Hyman Muss. Identifying pre-habilitation targets for the mitigation of long-term side effects of chemotherapy in patients with early breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-03-15.

Background: Delivery of cancer treatments, such as chemotherapy, requires a complex set of decisions that can change over time. Traditional measures of chemotherapy delivery, such as relative dose intensity, measure the amount of chemotherapy received by the end of treatment but mask the timing of dose reductions, delays, and discontinuation. These events may be important for delivering timely interventions to support adherence and lower the risk of recurrence. Materials and Methods: We used an institutional database to identify women diagnosed with stage I-III breast cancer receiving adjuvant chemotherapy with a standard 4-cycle regimen of docetaxel + cyclophosphamide (TC, every 21 days) from April 2014 to December 2019. LCD was calculated as the amount of a given chemotherapy agent delivered at a specified time, t, divided by the total planned standard chemotherapy dose at time t. We visualized LCD curves for each chemotherapy agent and reported the median LCD and interquartile range (IQR) at the end of the regimen, overall and by age group (<65 years vs. 65+ years). Results: The study population included 80 women. At the end of treatment, overall median LCDs for both cyclophosphamide and docetaxel were 100% (IQR: 99.6%, 100%), suggesting that TC was well tolerated. However, the lower quartile LCD for cyclophosphamide was 98.7% in older women treated with TC compared with 99.7% in younger women. Conclusion: Within our cohort, adjuvant TC was well tolerated with LCD curves showing largely on-time and full-dose administration. Subgroup analyses showed only slight decreases in adjuvant TC LCD for patients aged 65+ versus <65 years.

Cellular senescence is a prominent accomplice of aging. The expression of gene p16ink4a has been established as a biomarker of cellular senescence in humans and animal models. However, it has not been extensively studied in clinical settings in the context of natural aging and the development of age-related diseases. Here, we report the results of a natural aging study that provided an assessment of cellular senescence and a battery of measures of clinical status, quality of life (QOL), and physical performance in 250 community-dwelling participants across age continuum. This report focused on analyzing predictive relationships between cellular senescence and different clinical assessments. Our results suggest that clinical labs and QOL assessments produce distinct groupings of participants, yet both have strong predictive associations with p16ink4a. Furthermore, the highest accuracy of p16ink4a prediction requires subsets of measurements representing diverse aspects of each assessment, pointing towards a system-level role of p16ink4a. Our analysis also led to an assessment-based composite indexes that strongly correlate with p16ink4a expression. Our study underscores p16ink4a's association with both earlier signs of physiological decline (based on clinical labs) and the later onset of health issues limiting the quality of life.