Functional not chronologic age: Frailty index predicts outcomes in advanced ovarian cancer

Kumar, Amanika; Langstraat, Carrie; DeJong, Stephanie R.; McGree, Michaela E.; Bakkum-Gamez, Jamie N.; Weaver, Amy L.; LeBrasseur, Nathan K.; Cliby, William A.

doi:10.1016/j.ygyno.2017.07.126

Cited by 111 publications

(96 citation statements)

References 25 publications

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“…Fifteen studies6–12 20–27 were included in this systematic review, of which six studies were included in the meta-analysis 6–12. (Online supplementary Table S2 lists all excluded studies9 18 28–33 and the reasons for exclusion. )…”

Section: Resultsmentioning

confidence: 99%

Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis

Rinninella

Fagotti

Cintoni

et al. 2020

Int J Gynecol Cancer

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BackgroundMuscle mass plays a key role in predicting clinical outcomes in cancer. This systematic review and meta-analysis aimed to evaluate whether computed tomography (CT) scan indexes of muscle mass quantity and quality could be used as prognostic factors in ovarian cancer.MethodsThree electronic bibliographic databases (MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials) were used to conduct a systematic literature search from inception to January 2020. The primary outcome was overall survival. Pooled analyses of hazard ratios (HRs) and 95% confidence intervals (CIs) were performed with Review Manager 5.3. Heterogeneity was assessed by measuring inconsistency (I2 based on the χ2 test). Secondary outcomes included progression free survival, disease free survival, postoperative complications, and chemotoxicity. Study quality and quality of evidence were assessed.ResultsA total of 15 studies were included in the systematic review, of which six studies (1226 patients) were included in the meta-analysis. Summary unadjusted HRs (HR 1.11, 95% CI 0.84 to 1.46, p=0.47) and adjusted HRs (HR 1.10, 95% CI 0.84 to 1.43, p=0.49) did not show a significant association between low skeletal muscle index and overall survival (p>0.05) in ovarian cancer. Instead, although the quality of evidence was low, pooled data of three studies, comprising 679 patients, showed a significant association between low skeletal muscle radiodensity and poor overall survival (HR 1.63, 95% CI 1.28 to 2.07, p<0.0001). Moreover, the heterogeneity between studies precluded the possibility of performing a meta-analysis and reaching conclusions for progression free survival, disease free survival, surgical complications, and chemotoxicity.ConclusionsThis work suggested that the measurement of skeletal muscle radiodensity by routine CT scan at diagnosis, with standardization of diagnostic criteria, could be a reliable tool to select at risk patients and to individualize effective nutritional strategies. However, prospective homogeneous studies with a larger number of patients are required to confirm these results.

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Section: Resultsmentioning

confidence: 99%

Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis

Rinninella

Fagotti

Cintoni

et al. 2020

Int J Gynecol Cancer

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“…37 In the more complex oncologic patient, adverse surgical outcomes have also been shown to be related to frailty status in those undergoing surgery for various cancers (Table V). 7,8,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] Frailty has also been shown to predict tolerance to chemotherapy and radiotherapy, both of which have been associated with toxicity and decreased quality of life. The resulting intolerance and cessation of therapy has been associated with increased healthcare use and compromised cancer care.…”

Section: Frailty and Cancermentioning

confidence: 99%

Frailty in geriatric head and neck cancer: A contemporary review

et al. 2018

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Objective To provide a summary of the current frailty literature relating to head and neck cancer. Data Sources Ovid MEDLINE, PubMed, Google Scholar. Methods A comprehensive review of the literature was performed from 2000 to 2017 using key words frailty, elderly, geriatric, surgery, otolaryngology, head and neck cancer. Results The aging population has led to an increased diagnosis of head and neck cancer in elderly patients. The prevalence of comorbidities, disabilities, geriatric syndromes and social issues can make treatment planning and management in this population challenging. Chronological age alone may not be the optimal approach to guiding treatment decisions, as there is marked heterogeneity amongst this age group. Individualization of treatment can be achieved by assessing for the presence of frailty, which has growing evidence as an important marker of health status in geriatric oncology. Frailty is a complex geriatric syndrome characterized by a state of increased vulnerability to stressors and is associated with morbidity, mortality, and treatment toxicity. Screening for frailty may provide an efficient method to identify those who would benefit from further assessment or pretreatment optimization, and to provide prognostic information to assist clinicians and patients in formulating the most ideal treatment plan for the elderly individual with head and neck cancer. Conclusions Frailty has emerged as an important concept in geriatric oncology, with wide significance in head and neck cancer. Incorporating frailty assessments into clinical practice may provide otolaryngologists pertinent information regarding health status and outcomes leading to optimal care of the elderly cancer patient. Laryngoscope, 128:E416–E424, 2018

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“…33 Furthermore, the KPS was identified as an important prognostic factor among 286 patients with RCC metastases to the brain who received radiotherapy. 106,107 Frailty has been referred to as "functional age" compared with chronological age. 17 Extrapolating from the data regarding perioperative outcomes and oncologic outcomes after cytoreductive nephrectomy in mRCC, other potential prognostic factors that may be important to consider in selecting a patient for definitive treatment of metastatic deposits include nutritional status as measured by pretreatment and posttreatment hypoalbuminemia levels, which have been associated independently with 6-month and 12month CSM, respectively.…”

Section: Performance Status and Frailtymentioning

confidence: 99%

“…105 One area of research that has garnered substantial interest in recent years in the surgical oncology literature is the concept of frailty and how this relates to perioperative morbidity and mortality as well as oncologic outcomes. 106,107 Frailty has been referred to as "functional age" compared with chronological age. Lean muscle mass wasting (which, in its most severe form, may be characterized as sarcopenia) is quantified using metrics of lean muscle mass, such as the skeletal muscle index, and is considered an anatomic surrogate for frailty.…”

Section: Performance Status and Frailtymentioning

confidence: 99%

Role of metastasis‐directed treatment in kidney cancer

Psutka

Master

2018

Cancer

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Despite the rapid elaboration of multiple, novel systemic agents introduced for metastatic renal cell carcinoma (mRCC) in recent years, a durable complete response remains elusive with systemic therapy alone. Definitive treatment of the metastatic deposit remains the sole potentially curative option and is a cornerstone of mRCC therapy, offering potential for both local control and palliation of tumor-related symptoms. In this review, the evidence supporting the definitive treatment of mRCC is examined and summarized, including the use of surgical metastasectomy, thermal ablation, radiotherapy, and other minimally invasive options. Multimodal approaches, including the combination of metastasectomy with novel systemic agents, are discussed. Finally, the authors review considerations for patient selection for this type of therapy and summarize available risk-stratification tools that may help guide shared decision making.

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Functional not chronologic age: Frailty index predicts outcomes in advanced ovarian cancer

Cited by 111 publications

References 25 publications

Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis

Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis

Frailty in geriatric head and neck cancer: A contemporary review

Role of metastasis‐directed treatment in kidney cancer

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