Abstract
Older cancer patients are a highly heterogeneous population in terms of global health and physiological reserves, and it is often difficult to determine the best treatment. Moreover, clinical tools currently used to assess global health require dedicated time and lack a standardized end score. Circulating markers of biological age and/or fitness could complement or partially substitute the existing screening tools. In this study we explored the relationship of potential ageing/frailty biomarkers with age and clinical frailty. On a population of 82 young and 162 older non-metastatic breast cancer patients, we measured mean leukocyte telomere length and plasma levels of interleukin-6 (IL-6), regulated upon activation, normal T cell expressed and secreted (RANTES), monocyte chemotactic protein 1 (MCP-1), insulin-like growth factor 1 (IGF-1). We also developed a new tool to summarize clinical frailty, designated Leuven Oncogeriatric Frailty Score (LOFS), by integrating GA results in a single, semi-continuous score. LOFS' median score was 8, on a scale from 0=frail to 10=fit. IL-6 levels were associated with chronological age in both groups and with clinical frailty in older breast cancer patients, whereas telomere length, IGF-1 and MCP-1 only correlated with age. Plasma IL-6 should be further explored as frailty biomarker in cancer patients.
Highlights
Chronological age does not always accurately reflect functional status and life expectancy
Some attempts to summarize and categorize Geriatric assessment (GA) results have been proposed in geriatric oncology such as the Balducci score, but the included elements and cut-offs are arbitrary, and do not capture the complexity of the entire ageing process [4]
Several frailty models have been developed in general geriatrics, but Balducci and Extermann were the first to suggest a classification of cancer patients into 3 groups (‘fit’, ‘vulnerable’ and ‘frail’) depending on their GA result [33], with the purpose of guiding treatment decisions and predict life expectancy
Summary
Chronological age does not always accurately reflect functional status and life expectancy. Geriatric assessment (GA) is currently the gold standard to evaluate the global health status and clinical frailty level of individuals [1] and is feasible in clinical practice [2], but has several drawbacks It is time-consuming and difficult to integrate in routine clinical practice, the use of screening tools might partly overcome this problem [3]. GA corresponds with important outcome measures like patient survival and toxicity of treatment, its predictive capacity is moderate, and there is certainly room for better tools. As it does not yield a validated ‘end score’, it is difficult to precisely quantify the patients’ global health status. Some attempts to summarize and categorize GA results have been proposed in geriatric oncology such as the Balducci score, but the included elements and cut-offs are arbitrary, and do not capture the complexity of the entire ageing process (e.g. age ≥ 85 is sufficient to be categorized as ‘frail’, it has been stated in the geriatric literature that more than half of patients above 85 are not frail) [4]
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