Frailty is adversely associated with quality of life in patients with newly diagnosed pancreatic cancer

Abstract

Introduction: Decreased quality of life in patients with pancreatic cancer has been associated with poor performance status and increased mortality risk. Patients with newly diagnosed pancreatic cancer often present with frailty but the prevalence of this clinical syndrome and the extent to which it is associated with oncologic outcomes in these patients is unknown. We hypothesized that frailty is associated with decreased quality of life and other predictors of poor survival in pancreatic cancer. Objectives: To determine whether the presence of frailty syndrome correlateswith diminishedquality of life in patientswith pancreatic cancer. Methods: We prospectively measured frailty on the basis of Fried’s criteria (3 or more of the following: low grip strength, slow gait speed, weight loss, low physical activity, and exhaustion) in adult patients with newly diagnosed pancreatic cancer who presented to MD Anderson Cancer Center between July 2012 and May 2013. Nonparametric bivariate methods were used to evaluate the associations between self-reported Functional Assessment of Cancer Therapy – Hepatobiliary (FACT-Hep) symptom and quality of life scores and frailty, performance status, anatomic stage, and ACE-27 comorbidity scores. A multivariable regression model was constructed to determine whether frailty was associated with overall quality of life based on the total FACT-Hep score, when controlling for performance status and stage. Results: Of 143 patients enrolled, 73 (51%) were 65 years and older and 68% were male; 62 (43%) had metastases. Thirty-seven (25.9%) were frail. Frailty was not associated with either age or anatomic stage. Frailty was associated with increased hepatobiliary-associated symptoms (p b 0.001) and adversely associated with overall quality of life (mean total FACT-Hep 104.9 vs. 135.1, p b 0.001) as well as physical (p b 0.001), functional (p b 0.001), and emotional (p= 0.02) FACT-Hep subscale scores. Performance status and disease stage were significantly associated with decreased overall quality of life, but comorbidity was not. In a multivariable regression model, frailty remained significantly associated with the total FACTHep score when controlling for performance status and anatomic stage. Conclusion: Over one quarter of patients with a new diagnosis of pancreatic cancer met criteria for frailty syndrome, and frailty was associated with decreased quality of life. The prognostic implications of frailty syndrome for pancreatic cancer patients is being explored in this longitudinal study.