Frailty as determined by a comprehensive geriatric assessment‐derived deficit‐accumulation index in older patients with cancer who receive chemotherapy

Abstract

Background Frailty has been suggested as a construct for oncologists to consider in treating older cancer patients. Therefore we assessed the potential of creating a Deficit Accumulation Frailty Index (DAFI) from a largely self-administered comprehensive geriatric assessment (CGA). PATIENTS AND METHODS Five hundred patients age 65 and older received a CGA prior to receiving chemotherapy. A DAFI was constructed resulting in a 51 item scale and cut points for robust/non frail (0.0< 0.2), pre-frail (0.2<0.35) and frail (≥0.35) were examined. RESULTS Two Hundred and Fifty patients (50%) were non-frail, 197 (39%) pre-frail, 52 (11%) frail. Older patients (80+), lower education, living alone, and higher stage were associated with pre-frail/frail. Pre-frail/frail patient were more likely to have grade 3+ toxicity, but not to have dose delay or reduction, and were more likely to discontinue drug and be hospitalized. The association with grade 3+ toxicity was attenuated by controlling for a toxicity risk calculator but the other outcomes were not. CONCLUSION A Deficit Accumulation Frailty Index can be constructed from a CGA in older cancer patients and can indicate the frailty status of the population. The frailty status so determined is associated both with outcomes likely due to chemotherapy toxicity as well as those likely due to age related physiologic and functional deficits and thus can be useful in the overall assessment of the patient.

Frailty measure is more predictive of outcomes after curative therapy for endometrial cancer than traditional risk factors in women 60 and older

“…Cohen and Hurria recently used this method in their CGA cohort. Patients identified as frail by deficit-accumulation index were more likely to have serious toxicity, to be hospitalized, and to discontinue chemotherapy [25]. …”

Risk Factors for Chemotherapy-Related Toxicity and Adverse Events in Elderly Thai Cancer Patients: A Prospective Study

“…However, the results of those studies had explored specific aspects and were heterogeneous. To the best of our knowledge, this study is the first to expansively explore predictive factors for CRT and treatment modification due to AEs, including tumor factors, patient factors (especially CGA), social factors, as well as According to previous studies, factors related to chemotherapy-related AEs were poor functional status [6], malnutrition [6], age >72 years [25], gastrointestinal or genitourinary cancer [25], low hemoglobin [25], frailty [26], and moderate to severe comorbidities [20]. In the present study, PS remained the only predictive factor for severe AE from chemotherapy.…”

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)

“…5 Knowledge about system reserve could influence treatment decision-making, 3,6 and predict tolerance of systemic therapy and survival. 7-9 …”

“…7,10-12 Frailty is generally measured using one of two types of indices -- phenotypic, using a comprehensive clinical geriatric assessment focused on observed manifestations of system reserve failure (e.g., loss of muscle strength, fatigue), 10,11 and deficits accumulation based on illnesses and ability to function to perform daily activities. 13-16 …”

“…12,17-19 However, they are not frequently used in older cancer populations, 20 despite greater ease of use than comprehensive clinical geriatric assessments. When deficits accumulation indices have been applied in oncology settings, they have predicted initiation of hormonal therapy in older breast cancer patients, 21 chemotherapy toxicity, 7 accelerated cancer-related cognitive decline, 22 and two-year all-cause mortality. 20 However, there are no modern data on the ability of deficits accumulation indices to predict long-term breast cancer outcomes.…”