Differences in pretreatment frailty across gastrointestinal (GI) cancers in older adults: Results from the Cancer and Aging Resilience Evaluation (CARE) registry.

Abstract

542 Background: Frailty is an independent predictor of mortality in older adults and has been used to predict surgical complications and chemotherapy toxicities in GI cancers. How frailty differs between GI cancer types is unknown and could explain disparities in cancer outcomes. Our goal was to examine differences in pre-treatment frailty and geriatric assessment (GA) domain impairments between pancreatic, hepatobiliary, and colorectal cancers (CRC). We hypothesized that patients with more aggressive cancers (such as pancreatic cancer) would have increased frailty and more GA impairments, even prior to initiation of treatment. Methods: Our study included older adults age ≥60 years with cancer enrolled in the CARE Registry at the University of Alabama at Birmingham (UAB) who underwent a patient-reported GA during their initial visit with a GI medical oncologist. The GA was performed prior to any cancer-directed therapy. Frailty was defined using the 44-item CARE frailty index constructed based on principles of deficit accumulation described by Rockwood et al. We evaluated differences in frailty and GA domains between patients with CRC, pancreatic, and hepatobiliary cancers. Lastly, using a multivariable model we examined the adjusted odds ratio (aOR) of frailty by GI cancer type (reference CRC), adjusted for age, sex, race, cancer stage, and comorbidities. Results: Our study included 505 patients; 211 (41.8%) with CRC, 178 (35.2%) with pancreatic, and 116 (23.0%) with hepatobiliary cancers. Mean age of 70 years (standard deviation of 7) and 59% male. Cancer types did not differ by age, race, or sex. Patients with pancreatic and hepatobiliary cancers had more advanced cancer stage at time of assessment (stage IV 36.2% for CRC, 44.9% for pancreatic, and 45.2 for hepatobiliary; p=0.007). Older adults with pancreatic cancer had the highest prevalence of frailty (23.3% for CRC, 40.6% for pancreatic, and 34.3% for hepatobiliary; p=0.001), instrumental activities of daily living limitations (50.2% for CRC, 64.3% for pancreatic, and 52.7% for hepatobiliary; p=0.018), and malnutrition (40.8% for CRC, 70.3% for pancreatic, and 45.4% for hepatobiliary; p< 0.001). In multivariable analyses, older patients with pancreatic cancer had a 2.0 times higher odds of frailty in comparison to patients with CRC (aOR 2.0 95% CI 1.2-3.3, p=0.007). Conclusions: Older adults with pancreatic cancer had a higher prevalence of pre-treatment frailty, malnutrition, and functional impairments compared to CRC and hepatobiliary cancers. A focus on early intervention in these patients with optimization of nutrition and targeted physical/occupational therapy prior to and during treatment may help mitigate these factors and potentially improve outcomes.