Impact of Frailty on Survivals of Prostate Cancer Patients Treated with Radiotherapy

Pan, Yi-Ying; Meng, Lin-Chieh; Chen, Ho‐Min; Chen, Liang Kung; Hsiao, Fei‐Yuan

doi:10.1016/j.archger.2022.104651

Cited by 10 publications

(7 citation statements)

References 36 publications

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“…The diagnosis of dementia was defined as a diagnosis documented with 1 of following ICD‐9‐CM codes: 290.xx (dementias), 294.1x (dementia in conditions classified elsewhere) and 331.0 (Alzheimer disease) in discharge records. The multimorbidity frailty index (mFI) is based on the cumulative deficit approach for frailty, defined using a simple calculation for each diagnosis as a proportion of the total 32 diagnoses 46,47 . The mFI is a number between 0 and 1.…”

Section: Methodsmentioning

confidence: 99%

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The association of potentially inappropriate medications, polypharmacy and anticholinergic burden with readmission and emergency room revisit after discharge: A hospital‐based retrospective cohort study

Liang

Chou

Hsu

et al. 2022

Brit J Clinical Pharma

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Aims While certain drug‐use indicators are known to be associated with clinical outcomes, the relationship is unclear for some highly prevalent conditions in in patients aged ≥65 years. We examine correlations between 3 drug‐use indicators and postdischarge healthcare services use by older patients according to the presence of dementia, advanced age and frailty. Methods This retrospective cohort study analysed data collected from hospital electronic health records between April and December 2017. Potentially inappropriate medications (PIMs) and anticholinergic burden were assessed using the 2015 Beers Criteria and anticholinergic cognitive burden scale (ACBS) score. Minor and major polypharmacy were defined as the use of 5–9 and ≥10 drugs, respectively. Outcomes were set as emergency room revisits and readmissions at 1, 3 and 6 months postdischarge. The correlation between drug‐use indicators and outcomes was analysed by multivariable logistic regression. Results The final cohort included 3061 patients for the analysis, and 2930, 2671 and 2560 patients were followed up to 1, 3 and 6 months after discharge. After controlling for confounders, all 3 drug‐use indicators were significantly associated with readmission and emergency room revisits except for the relationship between PIMs and readmission within 6 months. These associations were significantly observed among patients without dementia, aged >80 years and with frailty. Conclusion PIMs, polypharmacy and anticholinergic burden are common at discharge and correlate with future use of healthcare services. In older patients, the absence of dementia, advanced age and frailty should be given extra consideration with regard to medication safety.

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Section: Methodsmentioning

confidence: 99%

“…The multimorbidity frailty index (mFI) is based on the cumulative deficit approach for frailty, defined using a simple calculation for each diagnosis as a proportion of the total 32 diagnoses. 46,47 The mFI is a number between 0 and 1. A larger mFI indicates greater frailty.…”

Section: Demographic Data Comorbidities and Comprehensive Geriatric A...mentioning

confidence: 99%

The association of potentially inappropriate medications, polypharmacy and anticholinergic burden with readmission and emergency room revisit after discharge: A hospital‐based retrospective cohort study

Liang

Chou

Hsu

et al. 2022

Brit J Clinical Pharma

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“…Hypouricaemia was associated with frailty, 9 which was associated with higher risks of both all-cause and cancer-specific mortality in patients with PCa. 10 Clinically, our findings suggest that baseline UA level may be used for prognosticating patients with PCa receiving ADT, warranting similar investigations in broader cohorts of patients with PCa. Additionally, although probenecid may abolish UA's effects on PCa cells in vitro, 3 UA-lowering medications did not meaningfully modify the captioned associations in our study.…”

Section: Discussionmentioning

confidence: 56%

“…Meanwhile, in those with below‐mean baseline UA levels, the inverse association may be explained by the low UA levels reflecting frailty. Hypouricaemia was associated with frailty, 9 which was associated with higher risks of both all‐cause and cancer‐specific mortality in patients with PCa 10 …”

Section: Discussionmentioning

confidence: 99%

Association between serum uric acid and prostate cancer mortality in androgen deprivation therapy: A population‐based cohort study

Lee

Chan²,

Leung

et al. 2023

Cancer Medicine

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ObjectiveThis population‐based study examined the association between baseline uric acid (UA) and prostate cancer (PCa)‐related mortality amongst PCa patients receiving androgen deprivation therapy (ADT).MethodsAdults with PCa who received ADT in Hong Kong between December 1999 and March 2021 were identified. Patients with missing baseline UA were excluded. Patients were followed up until September 2021. The outcome was PCa‐related mortality.ResultsAltogether, 4126 patients (median follow‐up 3.1[interquartile range 1.4–6.0] years) were included. A J‐shaped association was observed between baseline UA level and PCa‐related mortality risk, with a direct association in those with mean(0.401 mmol/L) or above‐mean baseline UA levels (hazard ratio (HR) per standard deviation‐increase 1.35 [95% confidence interval 1.21,1.51], p < 0.001), and an inverse association in those with below‐mean baseline UA levels (HR 0.78[0.67,0.92], p = 0.003). The former remained significant on competing risk regression, but not the latter.ConclusionsA J‐shaped relationship between baseline UA level and PCa‐related mortality risk was identified. This study was mainly limited by potential unmeasured and residual confounders. Further validation studies are warranted.

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“…These include general older adults, 17,27,28 diabetic patients 29 and prostate cancer patients. 30 Consequently, it can serve as a valuable tool for risk stratification. In this study, patients were classified into fit, mild frailty and severe frailty groups based on the tertile of their mFI-v10.…”

Section: Frailty Measurementmentioning

confidence: 99%

The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications

Lai,

Huang,

Anker

et al. 2024

J cachexia sarcopenia muscle

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BackgroundFrailty often coexists with heart failure (HF), which significantly aggravates the clinical outcomes of older adults. However, studies investigating the interplay between frailty and HF in older adults are scarce. We aimed to assess the prevalence of frailty using the cumulative deficit approach and evaluate the impacts of frailty on health utilization, use of HF‐related medications and adverse clinical outcomes (all‐cause mortality, all‐cause readmissions and HF readmissions) among older HF patients.MethodsA total of 38 843 newly admitted HF patients were identified from Taiwan's National Health Insurance Research Database and categorized into three frailty subgroups (fit, mild frailty and severe frailty) based on the multimorbidity frailty index. Cox regression models and Fine and Gray subdistribution hazard models were used to estimate the impacts of frailty on clinical outcomes at 1 and 2 years of follow‐up. Generalized estimating equation models were further conducted to evaluate the associations between longitudinal and time‐varying use of HF‐related medications and clinical outcomes among distinct frailty subgroups.ResultsOf 38 843 older HF patients (mean age 80.4 ± 8.5 years, 52.3% females) identified, 68.3% were categorized as frail (47.5% of mild frailty and 20.8% of severe frailty). The median number of readmissions (fit: 1 [inter‐quartile range—IQR 2], mild frailty: 1 [IQR 2] and severe frailty: 2 [IQR 3]) increased with the severity of frailty. Only 27.3% of HF patients died of cardiovascular diseases regardless of their frailty status. Compared with the fit group, the severe frailty group was associated with increased risk of all‐cause mortality (adjusted hazard ratio 1.16, 95% confidence interval [CI] 1.11–1.21), all‐cause readmissions (subdistributional hazard ratio (sHR) 1.21, 95% CI 1.16–1.25) and HF‐related readmissions (sHR 1.14, 95% CI 1.09–1.20) at 2 years of follow‐up. Those who used triple or more HF‐related medications were at lower risk for all‐cause readmissions (adjusted odds ratio [aOR] 0.49, 95% CI 0.44–0.54) and HF‐related readmissions (aOR 0.42, 95% CI 0.37–0.47) at 2 years of follow‐up even in the severe frailty group.ConclusionsFrailty is highly prevalent and associated with increased risk of all‐cause mortality, all‐cause readmissions and HF readmissions among older HF patients. Those who were using triple or more HF‐related medications were at lower risk of adverse clinical outcomes across distinct frailty subgroups. Further studies are needed to optimize the treatment strategies for older HF patients with distinct frailty status.

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Impact of Frailty on Survivals of Prostate Cancer Patients Treated with Radiotherapy

Cited by 10 publications

References 36 publications

The association of potentially inappropriate medications, polypharmacy and anticholinergic burden with readmission and emergency room revisit after discharge: A hospital‐based retrospective cohort study

The association of potentially inappropriate medications, polypharmacy and anticholinergic burden with readmission and emergency room revisit after discharge: A hospital‐based retrospective cohort study

Association between serum uric acid and prostate cancer mortality in androgen deprivation therapy: A population‐based cohort study

The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications

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