The prevalence and prognostic value of frailty screening measures in patients undergoing surgery for colorectal cancer: observations from a systematic review

McGovern, Josh; Dolan, Ross D.; Horgan, Paul G.; Laird, Barry

doi:10.1186/s12877-022-02928-5

Cited by 15 publications

(11 citation statements)

References 66 publications

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“…While an association between frailty and short-term outcomes (incidence of post-operative complications, length of stay and thirty-day mortality) has been widely reported in patients undergoing surgery for CRC, the basis of this relationship remains unclear. It has been postulated that an exaggerated systemic inflammatory response may be responsible for adverse clinical outcomes in frail patients [11]. Indeed, Soysal and co-workers reported an association between frailty and systemic inflammation in a recent systematic review and meta-analysis, in keeping with the present observations [14].…”

Section: Discussionsupporting

confidence: 88%

“…While the current literature suggests an association with frailty and clinical outcomes in patients undergoing surgery for CRC [7,11], the basis of relationship is unclear. Indeed, frailty been associated with prognostic, pre-operative host factors including malnutrition, sarcopenia and inflammation [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 98%

“…One such example is the American College of Surgeons National Surgical Quality Improvement Programs (ACS NSQIP) five-item modified frailty index (mFI-5 [10]. Scores were calculated on the presence of co-morbid disease and non-independent functional status, with increased mFI-5 scores associated with the incidence of post-operative complications and thirty-day mortality in older adults undergoing surgery for CRC [11].…”

Section: Introductionmentioning

confidence: 99%

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The relationship between the modified frailty index score (mFI-5), malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer

et al. 2023

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Background While the current literature suggests an association with frailty and clinical outcomes in patients undergoing surgery for colorectal cancer (CRC), the basis of this relationship is unclear. Aim Examine the relationship between frailty, malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer. Methods Consecutive patients who underwent potentially curative resection for colorectal cancer, between April 2008 and April 2018, were identified from a prospectively maintained database. Frailty was defined using the modified five-item frailty index (mFI-5). Body composition measures included CT-derived skeletal muscle index (SMI) and density (SMD). Systemic inflammatory status was determined using Systemic Inflammatory Grade (SIG). Outcomes of interest were the incidence of post-operative complications and thirty-day mortality. Associations between categorical variables were examined using χ2 test and binary logistics regression analysis. Results 1002 patients met the inclusion criteria. 28% (n = 221) scored 2 or more on the mFI-5. 39% (n = 388) of patients had a post-operative complication (Clavien-Dindo I-IV) and 1% (n = 11) died within thirty days of surgery. On univariate analysis, mFI-5 frailty score, was significantly associated with advanced age (p < 0.001), colonic tumours (p < 0.001), reduced use of neo-adjuvant chemotherapy (p < 0.05), higher BMI (p < 0.05), low SMD (p < 0.001), elevated NLR (p < 0.05), elevated mGPS (p < 0.05), elevated SIG (p < 0.05), incidence of post-operative complications (p < 0.001) and thirty-day mortality (p < 0.05). On multivariate analysis, male sex (p < 0.05), elevated SIG (p < 0.05) and mFI-5 score (p < 0.01) remained significantly associated with the incidence of post-operative complications. mFI-5 frailty was found to remain significantly associated with the incidence post-operative complications in patients who were SIG 0 (p < 0.05). Conclusion mFI-5 frailty score was found to be significantly associated with age, systemic inflammation and post-operative outcomes in patients undergoing potentially curative resections for CRC. Incorporation of an assessment of systemic inflammatory status in future frailty screening tools may improve their prognostic value.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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The relationship between the modified frailty index score (mFI-5), malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer

et al. 2023

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“…In terms of serious complications, the frail group had a higher incidence than the non-frail group. We also found that frailty has an important impact on the prognosis of patients with colorectal cancer, regardless of frailty screening tools, reported from multiple studies ( 24 – 26 ).…”

Section: Discussionsupporting

confidence: 57%

Frailty affects prognosis in patients with colorectal cancer: A systematic review and meta-analysis

Cai

Gao²,

Liao³

et al. 2022

Front. Oncol.

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BackgroundThe prevalence of colorectal cancer has remained high. Most patients have already developed into the middle and advanced stage when they are diagnosed with colorectal cancer, and a small number of them are accompanied by metastasis. In recent years, frailty has been recognized as an important factor affecting the prognosis of colorectal cancer. The aim of this study was to assess the value of frailty on prognosis in patients with colorectal cancer after treatment.MethodWe systematically searched PubMed, Embase, Web Of Science databases up until March2022. A total of 18 studies were retrieved that met the inclusion criteria, including 9 prospective studies and 9 retrospective studies. Frailty screening tools, proportion of frail patients, and outcomes of colorectal cancer patients after treatment were recorded.Result18 studies were included with a total of 352,535 participants. Regardless of differences in frailty screening and treatment approaches, outcomes for frailty patients were less favorable in all studies. Compared with the non-frail group, the frail group had higher mortality, more serious complications, more postoperative blood transfusions and delirium, and more support outside the home.ConclusionAlthough there is no uniform standard for frailty screening, assessing the frailty of colorectal cancer patients is of great significance for predicting prognosis of patients after treatment.

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“…McGovern et al [5] and Ding et al [6] found that patients undergoing colorectal and gastric cancer surgery had a large range of difference in their prevalence of preoperative frailty, but it remained at a high level of 12.0-56.0% and 8.5-45.9%, respectively. Frailty was found to be an independent predictor of postoperative complications, mortality, and overall survival in patients undergoing gastrointestinal cancer surgery [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer

Hui-pin

Zhang

Zhou

et al. 2022

Preprint

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Purpose We used three commonly used frailty assessment tools to investigate the current status of preoperative frailty and to analyse their predictive value for prognosis in patients undergoing surgery for gastrointestinal cancer. Methods This single-centre, observational, prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022. A total of 229 patients aged ≥ 18 years who underwent surgery for gastrointestinal cancer were included in this study. We collected the patients’ baseline data and used the Comprehensive Geriatric Assessment (CGA), Fried Phenotype (FP), and the FRAIL scale to assess frailty. The outcome measures were the complications experienced by patients and increased hospital costs. Results The prevalence of frailty was assessed using the CGA, FP, and FRAIL scale which returned the results 65.9%, 47.6%, and 34.9%, respectively. Multivariate logistic analysis confirmed that CGA was independently associated with increased hospital costs (OR = 2.514, 95% CI [1.202–5.258]; p = 0.014), and none of the frailty assessment tools were associated with total complications. Conclusions CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastrointestinal cancer.

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The prevalence and prognostic value of frailty screening measures in patients undergoing surgery for colorectal cancer: observations from a systematic review

Cited by 15 publications

References 66 publications

The relationship between the modified frailty index score (mFI-5), malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer

The relationship between the modified frailty index score (mFI-5), malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer

Frailty affects prognosis in patients with colorectal cancer: A systematic review and meta-analysis

Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer

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