Racial disparities in frailty and geriatric assessment impairments in older adults with cancer in the Deep South: Results from the CARE Registry

Abstract

BACKGROUND: Despite recent advances in cancer, racial disparities in treatment outcomes persist, and their mechanisms are still not fully understood. The objective of this study was to examine racial differences in frailty and geriatric assessment impairments in an unselected cohort of older adults with newly diagnosed gastrointestinal (GI) malignancies. METHODS: This study used data from the Cancer and Aging Resilience Evaluation Registry, a prospective cohort study that enrolled older adults (≥60 years) with GI malignancies who were presenting for their initial consultation. Participants who had a geriatric assessment completed before chemotherapy initiation and self-reported as either White or Black were included. Frailty was defined with a frailty index based on the deficit accumulation method. The differences in the prevalence and adjusted odds ratios for frailty and geriatric assessment impairments between Black and White participants were examined. RESULTS: Of the 710 eligible patients who were seen, 553 consented with sufficient data for analyses. The mean age at enrollment was 70 ± 7.1 years, 58% were male, and 23% were Black. Primary cancer diagnoses included colorectal cancer (32%), pancreatic cancer (27%), and hepatobiliary cancer (18%). Black participants were more likely to be frail (50.0% vs 32.7%; P < .001) and report limitations in activities of daily living (27.3% vs 14.1%; P = .001), instrumental activities of daily living (64.8% vs 47.3%; P = .002), and walking 1 block (62.5% vs 48.2%; P = .004). These associations persisted even after adjustments for age, sex, education, cancer type, cancer stage, and comorbidity. CONCLUSIONS: Black participants were frailer and reported more limitations in function in comparison with White participants. These findings may partially explain disparities in cancer outcomes and warrant further examination.

Equity

“…To be clear, we accept that “race and ethnicity are social constructs, without scientific or biological meaning.” 8 It behooves all of us to reject these observed differences in frailty and functionality as inevitable or acceptable, to probe into their causes, and to work to provide equitable care to all patients with cancer. Williams and colleagues 2 make this stance strongly in their article when they allude to “racial disparities,” and we agree with them.…”

“…These investigators even comment on the possibility that their findings could reflect nothing more than self‐reporting differences among various groups of patients, but this possibility seems less likely to us, as the investigators used more than 1 patient‐reported instrument to generate their results and reach their conclusions. More importantly, Williams and colleagues 2 outline the need to probe into the role of systemic inflammatory markers, which could mechanistically drive frailty and compromised functionality and which might be reflective of longstanding stress, detrimental exposures, suboptimal lifestyle habits, and other environmental factors in a subpopulation of older patients with cancer 15 . These investigators suggest that such translational work is an important next step to better understand their observations, and we agree.…”

“…In this context, the work from Williams and colleagues 2 is noteworthy. Recruiting 553 older patients who had been diagnosed with a gastrointestinal cancer and who had consented to be recruited into a single‐institution registry, these investigators examined baseline differences in health status according to race.…”

“…“Equity is the truth in action.” 1 In this issue of Cancer , Williams and colleagues 2 provide important observations that allow for actionable opportunities to improve the lives of older patients with cancer, most notably those patients of diverse backgrounds, including those who are Black, live in the Deep South, and have been diagnosed with a gastrointestinal malignancy. These investigators focused on the present‐day, extant circumstances that epidemiologists have been writing about for decades: More than 50 million Americans are now 65 years old or older; are at increasingly high risk for cancer because of aging; and are, as a cohort, growing in number 3 .…”

“…Yet, survey data show that, when caring for older patients with cancer, fewer than 30% of oncologists incorporate validated geriatric assessment tools into their clinical practice 13,14 . The fact that Williams and colleagues 2 constructed a registry that included a cancer geriatric assessment is admirable and enables the medical oncogeriatric and oncology communities at large to use these reported data to improve patient care.…”