Association between frailty syndrome and survival in patients with pancreatic adenocarcinoma

Abstract

Background Frailty is a syndrome characterized by weakness, slow gait, weight loss, exhaustion, and low activity. We sought to determine whether frailty was associated with age or stage in newly diagnosed patients with pancreatic ductal adenocarcinoma (PDAC), and determine its association with survival. Methods Consecutive patients with newly diagnosed PDAC of all stages underwent baseline assessment. Frailty (per Fried criteria) was defined as having three or more abnormalities in: grip strength, gait speed, weight loss, self‐reported exhaustion, or self‐reported physical activity. Baseline clinicodemographic characteristics, anatomic stage, performance status, and laboratory markers of prognosis were included. The association between baseline characteristics, frailty, and survival was determined. The associations of individual frailty measures with age, stage, comorbidities, and performance status were examined. Body composition was measured from computed tomographic images using SliceOMatic software. Results Of 150 patients enrolled, 8 were excluded because they did not have PDAC on final diagnosis. The median age was 65 years (range, 32‐89). Seventy‐nine patients (55.6%) were sarcopenic, and 36 (25.4%) were frail. Frailty was associated with increasing comorbidities (P = 0.03) and worse performance status (P < 0.01). During follow‐up, 79 patients (56%) died. Frailty was significantly associated with death during the follow‐up period (P < 0.001) for the entire cohort, including patients with curative (P = 0.038) and palliative (P = 0.003) treatment plans. Conclusions Frailty was seen frequently in patients with newly diagnosed PDAC and was not associated with increasing age or more advanced stage. Frailty was a predictor of survival, including patients treated with curative intent.

Prehabilitation for Hepatopancreatobiliary Surgical Patients: Interim Analysis Demonstrates a Protective Effect From Neoadjuvant Chemotherapy and Improvement in the Frailty Phenotype

“…This holds particularly true with pancreatic and biliary malignancies that frequently present with cachexia, frailty, and functional decline, regardless of age. 64 The frailty phenotype is also independent of cancer stage at diagnosis and associated with a significantly worse survival. Therefore, it becomes imperative to assess all patients for frailty and, further, attempt to improve physiologic status before major oncologic resection.…”

Home-Based Exercise Prehabilitation During Preoperative Treatment for Pancreatic Cancer Is Associated With Improvement in Physical Function and Quality of Life

“…19 Frailty, which is a syndrome characterized by weakness, slow gait, weight loss, exhaustion, and low activity, is prevalent among patients undergoing treatment for pancreatic cancer and has been associated with postoperative complications and reduced survival. 19,20 Sarcopenia has also been associated with reduced survival, but improved disease-free survival may be observed in patients in whom skeletal muscle is preserved during treatment. 5,21 Furthermore, patients receiving preoperative treatment may be at risk for further decline in physical function.…”

Slowness Predicts Mortality: A Comparative Analysis of Walking Speed and Moberg Picking-Up Tests

“…This phenotype was shown to be preceding functional decline in population-based studies, 3e5 and recent developments of research suggested an association with adverse outcomes in clinical settings, as it was also linked, among others, with surgical complications 6 or with mortality in patients with cancer. 7 In the process of operationalizing each frailty phenotype's dimension by measurable criteria, Fried et al separated participants according to the sex-specific 80th percentile (p80) for continuous variables. The time to perform a walking test at usual pace was dichotomized, and slowness was defined by a time > p80.…”