Abstract
PurposeTo assess the impact of frailty on compliance of standard therapy, complication, rate and survival in patients with gynecological malignancy aged 80 years and older.MethodsIn total, 83 women with gynecological malignancy (vulva, endometrial, ovarian or cervical cancer) who underwent primary treatment between 2007 and 2017 were retrospectively analyzed. Frailty index was calculated and its association with compliance of standard treatment, peri- and postoperative mortality and morbidity, and survival was evaluated.ResultsFrailty was observed in 24.1% of cases. Both frail and non-frail patients were able to receive standard therapy in most cases − 75.0% and 85.7%, respectively (p = 0.27). Frail patients did not show an increased postoperative complication rate. Frail patients had shorter 3 years overall survival rates (28%) when compared to non-frail patients (55%) (p = 0.02). In multivariable analysis high frailty index (Hazard Ratio [HR] 12.15 [1.39–106.05], p = 0.02) and advanced tumor stage (HR 1.33 [1.00–1.76], p = 0.05) were associated with poor overall survival, but not age, histologic grading, performance status, and compliance of standard therapy.ConclusionMajority of patients was able to receive standard therapy, as suggested by the tumor board, irrespective of age and frailty. Nonetheless, frailty is a common finding in patients with gynecological malignancy aged 80 years and older. Frail patients show shorter progression-free, and overall survival within this cohort.
Highlights
Life expectancy is consistently rising in developed countries
There was no difference in compliance of standard therapy, postoperative complication rate, and duration of hospitalization between frail and non-frail patients (Table 3)
Postoperative complications were typically mild without any death within 30 days after surgery and similar when non-frail patients were compared to frail patients
Summary
Life expectancy is consistently rising in developed countries. The rate of women older than 80 years is increasing [1]. Frailty is a chronically underdiagnosed condition reaching a prevalence ranging from 11 to 43% in the general population [3, 4]. In women in general and in female cancer patients in particular the prevalence of frailty is even higher [5, 6]. Frailty is a geriatric syndrome characterized by reduced homeostatic reserve, reduced capacity of coping with acute and environmental stressors, and poses the individual to higher risk of negative health-related outcomes [7]. Frail patients show increased risk of falls, disability, hospitalization and death [8,9,10]. Chemotherapy, and radiotherapy are possible stressors that can cause the transition to an unstable condition of frail patients
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