Frailty Index Developed From a Cancer-Specific Geriatric Assessment and the Association With Mortality Among Older Adults With Cancer

Guerard, Emily J.; Deal, Allison M.; Chang, Yeon S.; Williams, Grant R.; Nyrop, Kirsten A.; Pergolotti, Mackenzi; Muss, Hyman B.; Sanoff, Hanna K.; Lund, Jennifer L.

doi:10.6004/jnccn.2017.0122

Cited by 120 publications

(127 citation statements)

References 33 publications

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“…We examined three different models of frailty using data available in the Cancer and Aging Research Group tool to define frailty in our cohort: the IMWG frailty model [16], the R-MCI [17] and the CFI [18]. In the IMWG frailty index, frailty is categorized based on the Katz Activity of Daily Living (ADL), the Lawton Instrumental Activities of Daily Living (IADL) scale, the Charlson Comorbidity Index (CCI) and age.…”

Section: Definitions Of Frailtymentioning

confidence: 99%

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A comparison of three different approaches to defining frailty in older patients with multiple myeloma

Isaacs

Fiala

Tuchman

et al. 2020

Journal of Geriatric Oncology

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a b s t r a c tObjectives: As the aging population grows, interest in applying the concept of frailty to older adults with cancer has increased. This study examines the prevalence of frailty in older patients with multiple myeloma using three frailty models. Methods: In this secondary analysis of a prospective cohort study, 40 adults aged ≥65 with myeloma completed the Cancer and Aging Research Group geriatric assessment within three months of initial diagnosis. Geriatric assessment data was used to categorize patients' frailty status according to three indices: The International Myeloma Working Group (IMWG) Frailty Index, the Revised Myeloma Comorbidity Index (R-MCI), and the Carolina Frailty Index (CFI). Agreement between the indices was examined using Cohen's kappa. Results: Twenty-eight patients were classified as frail by at least one of the models. However, only slight agreement exists on the classification of frailty among the indices, with little concordance among the models (Kappa 0.03-0.12). Only three patients were categorized as frail by all three models. Conclusion: In a cohort of 40 older adults with newly diagnosed multiple myeloma, three frailty indices have differing approaches to operationalizing frailty resulting, in different patients being categorized as frail. Little agreement existed between the models. Further studies are needed to explore the utility of these models in predicting treatment toxicity and prognosis.

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Section: Definitions Of Frailtymentioning

confidence: 99%

“…Another model is the Carolina Frailty Index (CFI), developed in patients with various malignancies [18], which uses an accumulation of deficits approach. The accumulation of deficits approach predicts overall survival (OS) in patients with myeloma, though the CFI specifically has not been used in patients with myeloma [12].…”

Section: Introductionmentioning

confidence: 99%

A comparison of three different approaches to defining frailty in older patients with multiple myeloma

Isaacs

Fiala

Tuchman

et al. 2020

Journal of Geriatric Oncology

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“…The frailty phenotype is characterized by weakness, low physical activity, exhaustion, slow gait speed, and unintentional weight loss. In patients with cancer, the presence of frailty at the time of cancer diagnosis is predictive of all‐cause mortality . Older adults with cancer who are frail or pre‐frail are more likely to experience chemotherapy toxicity, to be hospitalized, or to discontinue chemotherapy treatment …”

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confidence: 99%

“…In patients with cancer, the presence of frailty at the time of cancer diagnosis is predictive of all-cause mortality. 4,5 Older adults with cancer who are frail or pre-frail are more likely to experience chemotherapy toxicity, to be hospitalized, or to discontinue chemotherapy treatment. 6 Although frailty is typically considered in the older adult population, studies in oncology examined the presence of frailty characteristics in younger cancer survivors due to the physiologic stress that cancer treatment induces.…”

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confidence: 99%

Longitudinal Relationship Between Frailty and Cognition in Patients 50 Years and Older with Breast Cancer

Magnuson

Lei

Gilmore

et al. 2019

J American Geriatrics Society

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OBJECTIVES To evaluate relationships between frailty and cognition longitudinally in adults 50 years and older with breast cancer receiving chemotherapy. DESIGN Secondary analysis of a prospective longitudinal observational study. SETTING University of Rochester NCI Community Oncology Research Program community oncology clinics. PARTICIPANTS Patients with breast cancer age 50 and older receiving adjuvant/neoadjuvant chemotherapy (n = 376) and age‐matched controls without cancer (n = 234). MEASUREMENTS Frailty was assessed using a modified frailty score from self‐reported assessments (weakness, exhaustion, physical activity, and gait speed). Cognition was assessed by patient report (Functional Assessment of Cancer Therapy‐Cognition [FACT‐Cog]) and objective measures. Frailty and cognition were measured at three time points (prechemotherapy [A1], postchemotherapy [A2], and 6 months postchemotherapy [A3]; similar time interval for controls). Linear regression models evaluated associations between frailty and cognition adjusting for covariates. RESULTS The average age was 59 years (standard deviation = 6.4 y). At baseline, patients with cancer had a higher mean frailty score (1.21 vs .73; P < .001) and lower mean FACT‐Cog score (158.4 vs 167.3; P < .001) compared with controls. Objective cognitive measures were not statistically different. Longitudinal decline in FACT‐Cog between A1 and A2 (P < .05) and between A1 and A3 (P < .01) was associated with increased frailty score in patients compared with controls. Longitudinal worsening in Controlled Oral Word Association (P < .05) and Trail‐Making Test (P < .01) were associated with an increase in frailty between A1 and A2 in patients compared with controls; longitudinal decline in the Delayed Match to Sample test was associated with an increase in frailty between A1 and A3 (P < .05) in patients compared with controls. This finding remained significant for a subset analysis of those aged 65 and older. CONCLUSION In patients with breast cancer aged 50 and older, longitudinal decline in FACT‐Cog and objective measures of attention and memory were associated with increased frailty during treatment and up to 6 months posttreatment. Overall, our study suggests cognition and frailty are both important factors to assess in breast cancer patients. J Am Geriatr Soc 67:928–936, 2019.

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“…Evidence of the need for cancer rehabilitation (defined as OT, PT, or both) strongly suggests that older adults engage with rehabilitation specialists to mitigate functional decline and improve mental health and QOL outcomes. [11][12][13][14][15] Occupational therapists (OTs) use a multitude of interventions to establish skills, maintain capacities, modify contexts (the environment in which, or the way an activity takes place), and prevent performance limitations (https://www.aota.org/About-Occupational-Therapy/Patients-Clients.aspx). 16 Physical therapists (PTs), in turn, assess musculoskeletal, neurologic, and cardiopulmonary systems to create patient-centered plans to reduce pain, improve or restore mobility and physical function, and prevent disability (http://www.apta.org/PTCareers/RoleofaPT/).…”

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confidence: 99%

Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy

Pergolotti

Deal

Williams

et al. 2019

J American Geriatrics Society

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OBJECTIVES The impact of occupational therapy (OT) and physical therapy (PT) on functional outcomes in older adults with cancer is unknown. DESIGN Two‐arm single‐institution randomized controlled trial of outpatient OT/PT. SETTING Comprehensive cancer center with two off‐site OT/PT clinics. PARTICIPANTS We recruited adults 65 years and older with a recent diagnosis or recurrence of cancer within 5 years, with at least one functional limitation as identified by a geriatric assessment. Participants were randomized to OT/PT or usual care. INTERVENTION Rehabilitation consisted of individualized OT and PT that addressed functional activities and strength/endurance needs. MEASUREMENTS Primary outcome was functional status as measured by the Nottingham Extended Activities of Daily Living scale. Secondary outcomes were Patient‐Reported Outcomes Measurement Information System‐Global Mental Health (GMH) and Global Physical Health (GPH), ability to participate in Social Roles (SR), physical function, and activity expectations and self‐efficacy (Possibilities for Activity Scale [PActS]). RESULTS Among those recruited (N = 63), only 45 patients (71%) were evaluable due to loss of follow‐up and/or nonreceipt of intervention. The median age was 74 years; 53% were female, and 91% were white. Overall, 30% patients had hematologic malignancies, 30% breast cancer, and 16% colorectal cancers. A total of 65% were in active treatment; 49% had stage 3 or 4 disease. At follow‐up, both OT/PT (P = .02) and usual care (P = .03) groups experienced a decline in functional status. PActS scores between groups (P = .04) was significantly improved in the intervention group. GMH and SR met criteria for minimally important clinical difference favoring the intervention, but not statistical significance. Several barriers were noted in the implementation of the intervention program: recruitment, concerns about cost, distance, scheduling, and limited treatment provided. CONCLUSION OT/PT may positively influence activity expectations and self‐efficacy. Future research needs to address significant barriers to implementation to increase use of OT/PT services and access to quality care. J Am Geriatr Soc 67:953–960, 2019.

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Frailty Index Developed From a Cancer-Specific Geriatric Assessment and the Association With Mortality Among Older Adults With Cancer

Cited by 120 publications

References 33 publications

A comparison of three different approaches to defining frailty in older patients with multiple myeloma

A comparison of three different approaches to defining frailty in older patients with multiple myeloma

Longitudinal Relationship Between Frailty and Cognition in Patients 50 Years and Older with Breast Cancer

Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy

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