How should older adults with cancer be evaluated for frailty?

Abstract

Traditionally used as a descriptive term, frailty is now a recognized medical syndrome identifying individuals with decreased physiologic reserve. Frailty is characterized by diminished strength, endurance, and reduced physiologic function. Several valid frailty screening tools exist in the literature, and these measures have been used to relate frailty to outcomes important to the older patient with cancer. Frail adults are at increased risk of adverse surgical outcomes and early findings suggest that frailty predicts poor chemotherapy tolerance. While much research is needed to explore the biologic relationships between frailty and cancer, there is an urgent need to implement frailty screening and management into the care of the older patient with cancer in order to improve outcomes in this vulnerable subset. The purpose of this paper is to provide an introduction of frailty to oncologists including a review of the definition, frailty screening tools, its clinical relevance to older patients with cancer, and a brief guide to frailty management.

Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients

“…In assessing preoperative risk, the comprehensive geriatric assessment (CGA) has been hailed as the “gold standard” in the identification of frailty in older patients, in the literature . However, the time required for its implementation has limited its use in busy clinics .…”

“…In assessing preoperative risk, the comprehensive geriatric assessment (CGA) has been hailed as the “gold standard” in the identification of frailty in older patients, in the literature . However, the time required for its implementation has limited its use in busy clinics . In contrast, mFI can be quickly calculated from information gathered from a standard history and physical examination, and has been found to be predictive of postoperative outcomes, including after major abdominal surgery .…”

“…First, mFI provides an objective measurement of frailty that can be easily calculated from a standard history and physical examination. Unlike the CGA, this makes the integration of mFI feasible for preoperative risk stratification . Additionally, the identification of frail patients does not preclude them from receiving potentially life‐saving therapies.…”

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

“…In this study, the authors state that frailty was evaluated by sarcopenia. However, this method of defining frailty is too limited and deviates somewhat from the usual definitions of frailty in oncology [2]. The authors found that body mass index, ASA classification, and comorbidity did not predict complications independently, while nutritional risk was an independent predictor of complications.…”

“…Older patients with impairments in the domains of GA may be considered frail if the impairments are across several domains or severe in one domain, such as dementia. The term frailty generally describes an individual with increased vulnerability towards stressors such as surgery or chemotherapy [2]. The goal of this paper is to assess the existing evidence of GA in GI malignancies (table 1), and to discuss implications for clinical practice.…”