Preoperative prevalence of multidimensional frailty and the associations with health-related quality of life in elderly cancer patients

Abstract

The frailty has been based on only physical in the previous studies, and neither cognitive and social frailty are clear in elderly cancer patients. The aims of this study are to estimate the preoperative prevalence of physical frailty, cognitive frailty, and social frailty and to determine the cross-sectional associations with health-related quality of life (HRQOL) in elderly cancer patients. We examined 190 cancer patients (≥ 60 years; mean age: 71.9 ± 7.0 years; 43 females) with esophageal, gastric, colorectal, oral, or pharyngeal cancers, who were scheduled to undergo the radical surgery. Physical frailty was defined as ≥ 3 out of the following criteria: slow walking speed, muscle weakness, exhaustion, low physical activity and weight loss. We used the validated tool assessed for cognitive impairments, which includes tests of word list memory, attention, and executive function, and processing speed to screen for cognitive impairments. Cognitive frailty was defined by the presences of ≥ 2 cognitive impairments and physical frailty. Social frailty was defined by ≥ 2 signs (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not talking with someone every day). HRQOL was measured using the EORTC QLQ-C30. The prevalence of each frailty was presented using a multiple imputation method. Associations between multidimensional frailty and the EORTC QLQ-C30 subscales were studied using multivariable regression analyses among complete cases. The prevalence of physical frailty, cognitive frailty, and social frailty were 32.9%, 4.7%, and 50.8%, respectively. Only social frailty was associated with the worse EORTC QLQ-C30 subscales (global QOL, physical functioning, role functioning, emotional functioning, cognitive functioning, fatigue and insomnia) after adjusting for covariates. Our results showed that the prevalence of frailty in elderly cancer patients were much more than that in population-based elderly, and preoperative HRQOL was especially affected by social frailty.