A simple test‐based frailty index to predict survival among cancer patients with an unplanned hospitalization: An observational cohort study

Hembree, Timothy N; Theou, Olga; Thirlwell, Sarah; Reich, Richard R.; Cao, Biwei; Sehovic, Marina; Syed, Misbahuddin; Verma, Neha; Nguyen, Thu-Cuc; Keerty, Dinesh; Wesolow, Jaqueline; Koverzhenko, Viktoriya; Extermann, Martine; Huang, Jessica; Ramsakal, Asha

doi:10.1002/cam4.4107

Cited by 6 publications

(4 citation statements)

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“…Across treatment contexts, few studies sought to demonstrate construct validity or to establish optimal FI categories. 20,41,50,53,56 This is the rst review to evaluate FI categorisation in older adults with cancer. Signi cant variability in FI categorisation has also been reported in a recent review of the most highly cited studies in older adults in the community, acute care, and residential care settings.…”

Section: Discussionmentioning

confidence: 99%

“…17,18,22,25,[30][31][32]36,37,39,40,44,[46][47][48]50,57,58 Fourteen studies included a range of cancers and the rest focused on individual cancer types. 20,[22][23][24][25]30,32,36,39,40,44,46,47,50,57,58 There were 10 studies of breast cancer, [17][18][19][26][27][28][29]33,37,56 of which six studies were different secondary analyses of the same prospective clinical trial. 19,26,27,33 Similarly, two 34,51 of the ve lung cancer studies utilised the same retrospective database, 34,35,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…39 Four of these studies de ned categories of increasing frailty, most often with 0.1 increments in FI. [47][48][49][50] References for these studies varied, including work by Rockwood and colleagues 59,60 One group de ned the optimum FI cut-off point for predicting adverse outcomes in women with advanced ovarian cancer. [53][54][55] An FI = 0.15 was the cut-off that yielded the highest Youden's index for their three binary outcomes (Accordion Grade 3 or 4 complication, 90-day mortality, receipt of chemotherapy within 42 days), while yielding the highest separation in outcome rates between frail and non-frail.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Fifteen studies were speci cally conducted in the medical oncology setting, 19,20,23,24,[26][27][28][29][33][34][35]38,43,51,54 eight studies in surgical oncology, 41,42,45,49,52,53,55,56 and the remainder were either mixed or not speci ed. 17,18,22,25,[30][31][32]36,37,39,40,44,[46][47][48]50,57,58 Fourteen studies included a range of cancers and the rest focused on individual cancer types. 20,[22][23][24][25]30,32,36,39,40,44,46,<...…”

Section: Study Characteristicsmentioning

confidence: 99%

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How frail is frail in oncology studies? A scoping review

Fletcher

Logan

Reid

et al. 2022

Preprint

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Aims:The frailty index (FI) is one way in which frailty can be quantified. While it is measured as a continuous variable, various cut-off points have been used to categorise older adults as frail or non-frail, and these have largely been validated in the acute care or community settings for older adults without cancer. This study aimed to explore which FI categories have been applied to older adults with cancer and to determine why these categories were selected by study authors.Methods:This scoping review searched Medline, EMBASE, and Cochrane databases for studies which measured and categorised an FI in adults with cancer. Of the 1165 screened, 40 were eligible for inclusion. Data including oncological setting, FI categories, and the references or rationale for categorisation were extract and analysed.Results:The FI score used to categorise participants as frail ranged from 0.06 to 0.35, with 0.35 being the most frequently used, followed by 0.25 and 0.20. The rationale for FI categories was provided in most studies but was not always relevant. Three of the included studies using an FI > 0.35 to define frailty were frequently referenced as the rationale for subsequent studies, however the original rationale for this categorisation was unclear. Few studies sought to determine or validate optimum FI categorises in this population.Conclusion:There is significant variability in how studies have categorised the FI in older adults with cancer. An FI ≥ 0.35 to categorise frailty was used most frequently, however an FI in this range has often represented at least moderate to severe frailty in other studies. These findings contrast with a scoping review of highly cited studies categorising FI in older adults without cancer, where an FI ≥ 0.25 was most common. Maintaining the FI as a continuous variable is likely to be beneficial until further validation studies determine optimum FI categories in this population. Disparities in how the FI has been categorised, and indeed how older adults have been labelled as ‘frail’, limits our ability to synthesise results and to understand the impact of frailty in cancer care.

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Section: Discussionmentioning

confidence: 99%