Frailty status but not age predicts complications in elderly cancer patients: a follow-up study

Abstract

Objectives: The purposes were to investigate the health status of elderly cancer patients by comprehensive geriatric assessment (CGA) and to compare the complications with respect to baseline CGA and to evaluate the need for geriatric interventions in an elderly cancer patients' population. Material: Patients aged !70 years with lung cancer (LC), cancer of the head and neck (HNC), colorectal cancer (CRC), or upper gastro-intestinal cancer (UGIC) are referred to the Department of Oncology for cancer treatment. Methods: CGA was performed prior to cancer treatment and addressed the following domains: Activities of daily living (ADL), instrumental ADL (IADL), comorbidity, polypharmacy, nutrition, cognition, and depression. Complications, defined as dose reduction and discontinuation of treatment due to grade 3-4 toxicity, hospital admission, shift to palliative treatment, or death within 90 days, were identified from the medical files. Patients were classified as fit, vulnerable, or frail by CGA. Principal results: Patients (N ¼ 217) with a median age of 75 years (range: 70-93 yeas) were included: 13% were fit, 35% vulnerable, and 52% frail. CGA significantly predicted admittance to hospital in frail and vulnerable patients compared to fit patients: risk ratio (RR) 2.12 (95% CI: 1.01; 4.46). Vulnerable and frail patients had higher absolute risk of death within 90 days compared to fit patients: 7% and 23% versus 0%. HR for death within 90 days in frail patients as compared to vulnerable patients was 3.50 (95% CI: 1.34; 9.15). More frail patients (88%) needed geriatric interventions than the vulnerable (46%) and fit patients (32%). Major conclusion: Few elderly cancer patients seem to be fit. CGA predicts admittance to hospital in a population of elderly patients with mixed cancer diseases. Frail and vulnerable patients have higher risk of death within 90 days as compared to fit patients.

The effect of treatment modifications by an onco-geriatric MDT on one-year mortality, days spent at home and postoperative complications

“…Many studies report on frailty as an independent predictor of adverse outcomes [6,[38][39][40]. There is, however, still a paucity of data regarding the effect of incorporating geriatric assessment (thereby assessing frailty) in treatment decision-making on patient outcomes.…”

Prognostic Factors Predict Oncological Outcome in Older Patients With Head and Neck Cancer Undergoing Chemoradiation Treatment

“…By applying CGA in cancer patients aged 70 years or older, a Danish study group found that up to 87% of patients with cancer types often seen in older patients and often connected to comorbidity were either vulnerable or frail. Patients with lung cancer, colorectal cancer, or gastrointestinal cancer and 14.6% of HNC patients were included in this study ( 23 ). The utility of CGA for older patients with HNC is currently under evaluation in ongoing trials such as GEROP (NCT03053310) or ELAN-ONCOVAL (NCT03614936).…”

Enhanced recovery after surgery (ERAS) programs for esophagectomy

“…Since patients with esophageal cancer are often malnourished, nutritional intervention should be undertaken (14). Available data also shows that frailty rather than age is a major risk factor of perioperative complications (15). This evidence suggests including patient tailored physical activity in the time between diagnosis and the surgical procedure (16)(17)(18).…”