Abstract
BackgroundFrailty is an indicator of physiological reserve in older people. In non-cancer settings, frailty indices are reliable predictors of adverse health outcomes. The aims of this study were to 1) derive and validate a frailty index (FI) from comprehensive geriatric assessment (CGA) data obtained in the solid tumour chemotherapy setting, and 2) to explore whether the FI-CGA could predict chemotherapy decisions and survival in older cancer patients with solid tumours.MethodsProspective cohort study of a consecutive series sample of 175 cancer patients aged 65 and older with solid tumours. A frailty index was calculated using an accumulated deficits model, coding items from the comprehensive geriatric assessment tool administered prior to chemotherapy decision-making. The domains of physical and cognitive functioning, nutrition, mood, basic and instrumental activities of daily living, and comorbidities were incorporated as deficits into the model.ResultsThe FI-CGA had a right-skewed distribution, with median (interquartile range) of 0.27 (0.21–0.39). The 99% limit to deficit accumulation was below the theoretical maximum of 1.0, at 0.75. The FI-CGA was significantly related (p < 0.001) to vulnerability as assessed by the Vulnerable Elders Survey-13 and to medical oncologists’ assessments of fitness or vulnerability to treatment. Baseline frailty as determined by the FI-CGA was also associated with treatment decisions (Treatment Terminated, Treatment Completed, No Planned Treatment) (p < 0.001), with the No Planned Treatment group significantly frailer than the other two groups.ConclusionThe FI-CGA is a potentially useful adjunct to cancer clinical decision-making that could predict chemotherapy outcomes in older patients with solid tumours.
Highlights
Frailty is an indicator of physiological reserve in older people
The frailty index (FI), which is a continuous measure ranging from 0 to a theoretical maximum of 1.0, is calculated by dividing the number of deficits identified in the comprehensive geriatric assessment (CGA) by the total number of variables measured
The results demonstrate that the FI based on the CGA (FI-CGA) is a clinically feasible tool to predict chemotherapy outcomes in older patients with solid tumours
Summary
In non-cancer settings, frailty indices are reliable predictors of adverse health outcomes. The aims of this study were to 1) derive and validate a frailty index (FI) from comprehensive geriatric assessment (CGA) data obtained in the solid tumour chemotherapy setting, and 2) to explore whether the FI-CGA could predict chemotherapy decisions and survival in older cancer patients with solid tumours. The aim of the study was to derive and validate a frailty index (FI) from ‘Frailty’ is the accumulation of multiple physical and psychosocial deficits in the older person [7]. The frailty index (FI), which is a continuous measure ranging from 0 to a theoretical maximum of 1.0, is calculated by dividing the number of deficits identified in the CGA by the total number of variables measured. The FI has a theoretical maximum of 1.0 [10]
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