The Association of Preoperative Frailty and Neighborhood-Level Disadvantage with Outcome in Patients with Newly Diagnosed High Grade Glioma

Mirpuri, Pranav; Singh, Maharaj; Rovin, Richard

doi:10.1016/j.wneu.2022.07.138

Cited by 9 publications

(4 citation statements)

References 30 publications

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“…Ultimately, while studies have connected increased frailty in patients with GBM to malnutrition [ 50 ], poor follow-up care [ 23 ], and decreased temporal muscle thickness [ 25 , 27 ], many studies define frailty using incomparable metrics. This overall lack of standardization combined with GBM’s progressive nature may be contributing to disputes regarding frailty’s role in guiding care for geriatric patients with malignant primary brain tumors.…”

Section: Discussionmentioning

confidence: 99%

Frailty and postoperative outcomes in brain tumor patients: a systematic review subdivided by tumor etiology

Qureshi,

Tabor,

Pickens

et al. 2023

J Neurooncol

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Purpose Frailty has gained prominence in neurosurgical oncology, with more studies exploring its relationship to postoperative outcomes in brain tumor patients. As this body of literature continues to grow, concisely reviewing recent developments in the field is necessary. Here we provide a systematic review of frailty in brain tumor patients subdivided by tumor type, incorporating both modern frailty indices and traditional Karnofsky Performance Status (KPS) metrics. Methods Systematic literature review was performed using PRISMA guidelines. PubMed and Google Scholar were queried for articles related to frailty, KPS, and brain tumor outcomes. Only articles describing novel associations between frailty or KPS and primary intracranial tumors were included. Results After exclusion criteria, systematic review yielded 52 publications. Amongst malignant lesions, 16 studies focused on glioblastoma. Amongst benign tumors, 13 focused on meningiomas, and 6 focused on vestibular schwannomas. Seventeen studies grouped all brain tumor patients together. Seven studies incorporated both frailty indices and KPS into their analyses. Studies correlated frailty with various postoperative outcomes, including complications and mortality. Conclusion Our review identified several patterns of overall postsurgical outcomes reporting for patients with brain tumors and frailty. To date, reviews of frailty in patients with brain tumors have been largely limited to certain frailty indices, analyzing all patients together regardless of lesion etiology. Although this technique is beneficial in providing a general overview of frailty’s use for brain tumor patients, given each tumor pathology has its own unique etiology, this combined approach potentially neglects key nuances governing frailty’s use and prognostic value.

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Section: Discussionmentioning

confidence: 99%

Frailty and postoperative outcomes in brain tumor patients: a systematic review subdivided by tumor etiology

Qureshi,

Tabor,

Pickens

et al. 2023

J Neurooncol

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“…5,6 Recently, frailty has been investigated as a predictor for outcomes of patients with HGGs treated with surgery and adjuvant therapy. [7][8][9] Research has consistently shown a correlation between frailty metrics and postoperative outcomes. 10,11 The predictive value of frailty and other risk factors has been speci cally investigated in older adults undergoing surgical treatment for HGGs as age is an additional risk factor excluded from the mFI-5 that may impact outcomes of surgery in this population.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Predictive Value of the Modified Frailty Index (mFI-5) on Postoperative Outcomes in Patients with High-Grade Gliomas

Zaki,

Herr,

Doori

et al. 2024

Preprint

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Purpose: High-grade gliomas (HGGs) are aggressive brain tumors associated with significant morbidity. This study aims to assess the utility of the 5-factor Modified Frailty Index (mFI-5) in predicting postoperative outcomes and overall survival in patients undergoing surgical resection for HGGs.Methods: We conducted a retrospective analysis of 196 patients treated surgically for GBM at our institution from January 2016 to January 2023. Patients were stratified into three groups based on their preoperative mFI-5 scores: prefrail (< 2), frail (= 2), and severely frail (> 2). Primary outcomes included 30-day, 90-day, and 1-year survival and progression-free survival. Secondary outcomes focused on hospital length of stay (LOS), 30-day readmission rates, and discharge status. Univariate and multivariate analyses evaluated the impact of frailty on these outcomes.Results: Frailty was significantly associated with adverse outcomes. The median progression free survival was 9.2 months in the prefrail, 6.9 months in the frail and 3.5 months in severely frail patients (p = 0.01). Furthermore, the 90-day OS was 89%, 91% and 75% for the prefrail, frail and severely frail group respectively (p = 0.03). However, there was no statistically significant difference in 12-month OS (64%, 70%, 58%; p = 0.72). The median survival for the cohort was 17.9 months in the prefrail, 15.4 months in the frail and 15.3 in the severely frail (p = 0.02). Severely frail patients demonstrated lower rates of symptomatic resolution (66%,53%, 33% respectively; p = 0.005), increased non-home discharge rates (24%, 55.9%, 75%, respectively; P < 0.001), and mRS > 2 upon discharge (5%, 26%, and 66% respectively; P < 0.001).Conclusion: The mFI-5 is a valuable tool for preoperative risk stratification in patients with GBM, predicting short-term survival and postoperative outcomes. Integrating frailty assessments into preoperative evaluations can aid in tailoring surgical and adjuvant therapies, potentially improving patient outcomes and optimizing resource allocation. This study supports the adoption of frailty assessments in neuro-oncological practice to enhance personalized care strategies for patients with HGGs.

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“… 12 – 16 While they have independently demonstrated robust capabilities at predicting surgical outcomes, the association between neighborhood socioeconomic disadvantage and frailty presentation have remained unexplored. 17 – 20 …”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14][15][16] While they have independently demonstrated robust capabilities at predicting surgical outcomes, the association between neighborhood socioeconomic disadvantage and frailty presentation have remained unexplored. [17][18][19][20] The aim of this study is to determine the association of ADI and SVI with frailty measured by FFP and mFI-5. We hypothesize that general thoracic surgery patients with greater neighborhood socioeconomic deprivation will tend to be more frail.…”

Section: Introductionmentioning

confidence: 99%

The association between neighborhood disadvantage and frailty: A retrospective case series

Fenton,

Allen,

Kent

et al. 2024

Journal of Public Health Research

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Background: Frailty predicts poorer outcomes in surgical patients. Recent studies have found socioeconomic status to be an important characteristic for surgical outcomes. We evaluated the association of Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), two geospatial atlases that provide a multidimensional evaluation of neighborhood deprivation, with frailty in a surgery population. Design & methods: A retrospective study of patients undergoing routine frailty screening was conducted 12/2020–8/2022. Frailty was measured using Fried’s Frailty Phenotype (FFP) and the five-item Modified Frailty Index (mFI-5). ADI and SVI quartiles were determined using patient residence. Logistic regression models were used to evaluated associations of FFP (frail only vs not frail) and mFI-5 (≥2 vs 0–1) with ADI and SVI (α = 0.05). Results: Of 372 screened patients, 41% (154) were women, median age was 68% (63–74), and 46% (170) identified as non-White. Across ADI and SVI quartiles, higher number of comorbidities, decreasing median income, and frailty were associated with increasing deprivation ( p < 0.01). When controlling for age, sex, comorbidities, and BMI category, frailty by FFP was associated with the most deprived two quartiles of ADI (OR 2.61, CI: [1.35–5.03], p < 0.01) and the most deprived quartile of SVI (OR 2.33, [1.10–4.95], p < 0.05). These trends were also seen with mFI-5 scores ≥2 (ADI: OR 1.64, [1.02–2.63], p < 0.05; SVI: OR 1.71, [1.01–2.91], p < 0.05). Conclusions: Surgical patients living in socioeconomically deprived neighborhoods are more likely to be frail. Interventions may include screening of disadvantaged populations and resource allocation to vulnerable neighborhoods.

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The Association of Preoperative Frailty and Neighborhood-Level Disadvantage with Outcome in Patients with Newly Diagnosed High Grade Glioma

Cited by 9 publications

References 30 publications

Frailty and postoperative outcomes in brain tumor patients: a systematic review subdivided by tumor etiology

Frailty and postoperative outcomes in brain tumor patients: a systematic review subdivided by tumor etiology

Evaluating the Predictive Value of the Modified Frailty Index (mFI-5) on Postoperative Outcomes in Patients with High-Grade Gliomas

The association between neighborhood disadvantage and frailty: A retrospective case series

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