@article{b12f05799d5e4887b6e76ef354c9e85e,
title = "A deficit-accumulation frailty index predicts survival outcomes in patients with gynecologic malignancy",
abstract = "Objective: To determine the association between scores from a 25-item patient-reported Rockwood Accumulation of Deficits Frailty Index (DAFI) and survival outcomes in gynecologic cancer patients. Methods: A frailty index was constructed from the SEER-MHOS database. The DAFI was applied to women age ≥ 65 diagnosed with all types of gynecologic cancers between 1998 and 2015. The impact of frailty status at cancer diagnosis on overall survival (OS) was analyzed using Kaplan-Meier curves and Cox proportional hazards regression. Results: In this cohort (n = 1336) the median age at diagnosis was 74 (range 65–97). Nine hundred sixty-two (72%) women were Caucasian and 132 (10%) were African-American. Overall, 651(49%) of patients were considered frail. On multivariate analysis, frail patients had a 48% increased risk for death (aHR 1.48; 95% CI 1.29–1.69; P < 0.0001). Each 10% increase in frailty index was associated with a 16% increased risk of death (aHR, 1.16; 95% CI, 1.11 to 1.21; P < 0.0001). In subgroup analyses of the varying cancer types, the association of frailty status with prognosis was fairly consistent (aHR 1.15–2.24). The DAFI was more prognostic in endometrial (aHR 1.76; 95% CI 1.41–2.18, P < 0.0001) and vaginal/vulvar (aHR 1.94; 95% CI 1.34–2.81, P = 0.0005) cancers as well as patients with loco-regional disease (aHR 1.94; 95% CI 1.62–2.33, P < 0.0001). Conclusions: Frailty appears to be a significant predictor of mortality in gynecologic cancer patients regardless of chronological age. This measure of functional age may be of particular utility in women with loco-regional disease only who otherwise would have a favorable prognosis.",
author = "Mullen, {Mary M.} and McKinnish, {Tyler R.} and Fiala, {Mark A.} and Zamorano, {Abigail S.} and Kuroki, {Lindsay M.} and Fuh, {Katherine C.} and Hagemann, {Andrea R.} and McCourt, {Carolyn K.} and Mutch, {David G.} and Powell, {Matthew A.} and Wildes, {Tanya M.} and Thaker, {Premal H.}",
note = "Funding Information: This project in part was supported by The Foundation for Barnes-Jewish Hospital and their generous donors; and the Washington University Institute of Clinical and Translational Sciences which is, in part, supported by the NIH / National Center for Advancing Translational Sciences (NCATS), CTSA grant UL1 TR002345.” Funding Information: This project in part was supported by The Foundation for Barnes-Jewish Hospital and their generous donors; and the Washington University Institute of Clinical and Translational Sciences which is, in part, supported by the NIH/National Center for Advancing Translational Sciences (NCATS), CTSA grant UL1 TR002345.”This study used data from the SEER-MHOS linked data resource. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-MHOS database. The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ). Funding Information: The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ) . Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",
year = "2021",
month = jun,
doi = "10.1016/j.ygyno.2021.02.027",
language = "English",
volume = "161",
pages = "700--704",
journal = "Gynecologic oncology",
issn = "0090-8258",
number = "3",
}