The association of cancer diagnosis with frailty status in high need, high risk veterans.

Abstract

e24024 Background: Frailty, a common geriatric condition, is characterized by a vulnerability to stressors caused by multisystem dysfunction associated with poor clinical outcomes. Patients with frailty are often High-Need High-Risk (HNHR), a group with higher levels of healthcare utilization. Cancer diagnosis could increase the incidence of frailty in this group by several mechanisms: immunosenescence, chronic inflammation, potentially harmful effects of therapies and associated comorbidities. The study aim was to determine the cross-sectional association of cancer with frailty status in High Need, High Risk veterans. Methods: This was a cross-sectional study of HNHR Veterans in the Veterans Integrated Service Network 8 identified through quarterly reports run by VA predictive analytic models. We compared Veterans with and without cancer in terms of frailty status, sociodemographic characteristics, substance or alcohol abuse and number of medications. Frailty was defined using a 30-item VA Frailty Index (VA-FI, excluding cancer) generated as a proportion based on the number of items present. We compared non-frail (robust = 0–0.1, and pre-frail = 0.11–0.20), and frail (mild = 0.21–0.30, moderate = 0.31–0.40, and severe = > 0.4). After adjusting for gender, age, alcohol abuse, tobacco abuse and number of medications, we performed a multinomial logistic regression using odds ratios (OR) with 95% confidence intervals (CI) with cancer as the independent variable and frailty status as the dependent variable. Results: A total of 10916 Veterans were included in the analysis, mean age 68.5 (SD = 11.8) years, 93.4% male, 74.7% Caucasian, 18.0% Black, 7.4% Hispanic, 8710 (79.8%) frail and 3641 (36.1%) had Cancer. Of those with cancer, frail = 3358 (85.2%) vs. non-frail = 583 (14.8%) (p < .0001). After multivariate multinomial logistic regression, the presence of cancer was associated with being severely frail as compared to robust, adjusted OR:2.3(95%C.I.:1.8-2.9), p < 0.0001. Conclusions: In this HNHR veteran population, cancer had a positive, cross-sectional association with frailty. Identifying HNHR patients with cancer may assist clinicians in the implementation of targeted clinical interventions that may prevent or reverse frailty status and associated poor clinical outcomes. More research is needed to better determine the impact of cancer on frailty diagnosis.