Patient‐reported geriatric assessment‐based frailty index among older adults with gastrointestinal malignancies

Abstract

Background Older adults with cancer are at increased risk of treatment‐related toxicities and excess mortality. We evaluated whether a patient‐reported geriatric assessment (GA) based frailty index can identify those at risk of adverse outcomes. Methods Older adults (≥60 years) enrolled in a single‐institutional prospective registry underwent patient‐reported GA at initial evaluation in our medical oncology clinic. Using deficit accumulation method, we constructed a 44‐item frailty index (CARE‐FI), categorizing patients as robust, pre‐frail, and frail. The primary outcome was overall survival (OS). Secondary outcomes included (a) functional decline at 3 months post‐therapy (b) incident grade ≥3 treatment‐related toxicities at six‐month post‐treatment. We used multivariate Cox and logistic regression models respectively to study the impact of frailty on primary and secondary outcomes. Results We identified 589 older adults with a median age of 69 years; 55% males and 73% Whites. Overall, 168 (29%) were pre‐frail and 230 (39%) frail. Being frail (vs. robust) was associated with worse OS (Hazards Ratio, HR 1.83, 95% Confidence Interval, CI 1.34–2.49, p < 0.001) after adjusting for age, sex, race/ethnicity, cancer type, cancer stage, and line of therapy. Similarly, frailty was associated with increased risk of functional decline (OR 3.01; 95% CI 1.33–6.81; p = 0.008) and grade ≥3 non‐hematologic toxicities (OR 3.65; 95% CI 1.54–8.69; p = 0.003) but not hematologic toxicities (OR 1.01; 95% CI 0.46–2.22; p = 0.97). Conclusions Our frailty index using a patient‐reported GA is a robust predictor of survival, functional decline, and treatment related toxicity among older adults with GI malignancies.

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Questions and Answers

“…Once the GA is completed, the results can be used to identify individual domain impairments, calculate a summary score of overall frailty, [19][20][21] and calculate the risk of severe chemotherapy toxicities (see ASCO videos). For treatment decision making, it can be very helpful to integrate the risk of adverse outcomes and/or severe chemotherapy toxicities on the basis of the GA results to inform a conversation about the risks/benefits of cancer treatments for individual patients.…”

Association of unmet basic resource needs with frailty and quality of life among older adults with cancer—Results from the CARE registry

“…Using the principles of deficit accumulation and following the procedures outlined by Searle et al, 24 we constructed the CARE Frailty Index 25 . Based on 44 identified health deficits from the CARE geriatric assessment tool, the CARE Frailty Index was calculated as the proportion of deficits for each patient (range 0–1).…”

“…Participants were required to have nonmissing data for at least 30 items in order to compute a valid frailty score and were categorized as robust (0–0.2), prefrail (0.2–0.35), and frail (>0.35), as previously described 24 . Our team has previously shown that the CARE frailty index predicts functional decline, severe chemotherapy toxicities, and survival among older adults; 25 similarly constructed frailty indices have shown comparable results 12–15,26 . See Table S1 for a full list of the CARE frailty index items.…”

The association between food access and frailty among older adults with gastrointestinal malignancies—The CARE Registry

“…26 Detailed methodology for calculating the CARE FI is described elsewhere and in Table S2. 11,27 Briefly, each item queried the presence or absence of a health deficit across GA domains and was scored as 0 (absence of deficit), 0.5 (intermediate response [e.g. sometimes/ maybe]), or 1 (presence of deficit).…”

“…9 Frailty can also increase the risk for treatment toxicity, reduced health-related quality of life, institutionalization, and mortality. [9][10][11][12] Therefore, whereas the relative effect of frailty in older adults with cancer is similar to that without cancer, the cumulative effect becomes greater in those with cancer.…”