TY - JOUR
T1 - Patient-reported geriatric assessment-based frailty index among older adults with gastrointestinal malignancies
AU - Giri, Smith
AU - Al-Obaidi, Mustafa
AU - Harmon, Christian
AU - Clark, Deanna
AU - Ubersax, Clare
AU - Dai, Chen
AU - Young-Smith, Crystal
AU - Outlaw, Darryl
AU - Gbolahan, Olumide
AU - Khushman, Moh'd
AU - Bhatia, Smita
AU - Williams, Grant R.
N1 - Funding Information:
Supported in part by the Walter B. Frommeyer Fellowship in Investigative Medicine at the University of Alabama at Birmingham and the National Cancer Institute of the National Institutes of Health (K08CA234225). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2022 The American Geriatrics Society.
PY - 2023/1
Y1 - 2023/1
N2 - 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.
AB - 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.
KW - cancer
KW - frailty index
KW - geriatric assessment
KW - older adults
UR - http://www.scopus.com/inward/record.url?scp=85139460733&partnerID=8YFLogxK
U2 - 10.1111/jgs.18054
DO - 10.1111/jgs.18054
M3 - Article
C2 - 36208421
AN - SCOPUS:85139460733
SN - 0002-8614
VL - 71
SP - 136
EP - 144
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 1
ER -