New Frailty Index Associated With Outcomes in Older Patients on Chemotherapy

A largely self-administered comprehensive geriatric assessment can be used to create a deficit-accumulation frailty index in cancer patients undergoing chemotherapy, a new study found. That index was found to be associated with outcomes both related to chemotherapy toxicity and to age-related outcomes.

Previous work has suggested that frailty may be useful in understanding the vulnerability of older patients. “This may be of value when oncologists contemplate treatment for older patients with cancer as a way to determine where on the spectrum each patient is positioned to facilitate planning management approaches,” wrote study authors led by Harvey Jay Cohen, MD, of Duke University Medical Center in Durham, North Carolina. The study was published online ahead of print in Cancer.

The new study included 500 patients aged at least 65 years; the comprehensive geriatric assessment (CGA) was performed before initiation of chemotherapy, evaluating patients’ functional status, comorbidity, cognition, and other factors. The CGA took less than 30 minutes, all but five of which were self-reported. From that, a 51-item scale was created to derive the deficit-accumulation frailty index (DAFI); these included items such as frequency of falls, number of medications, levels of social activity and support, basic lab values, and others.

The DAFI showed that 250 patients (50%) were deemed robust/non-frail (index cutoff value 0.0 < 0.2), 197 patients (39%) were pre-frail (cutoff value, 0.2 < 0.35), and 52 patients (11%) were frail (cutoff value, ≥ 0.35).

A multivariate analysis showed that several variables were significantly associated with frailty. Age of 80 years or older had an odds ratio for pre-frailty of 2.68 (95% CI, 1.58–4.54; P = .0003) and for frailty of 2.78 (95% CI, 1.31–5.93; P = .008). Education level of high school or below, living alone, and stage IV disease were all also associated with both pre-frailty and frailty.

On a univariate analysis, grade 3 or higher toxicity was significantly associated with frailty, but this was not significant after adjustments. Chemotherapy discontinuation did maintain significant associations with frailty, with an adjusted relative risk (RR) of 2.06 (95% CI, 1.26–3.38; P = .004). Hospitalization was also significantly associated with frailty, with an adjusted RR of 1.98 (95% CI, 1.26–3.11; P = .003). Dose reductions and dose delays were not associated with the DAFI values.

“The frailty index determined from a CGA provides a summary measure that may prove useful to oncologists who are increasingly seeking to use the concept of frailty to direct treatment decisions,” the authors wrote. They noted that the study is limited by a restriction to only grade 3 or higher toxicity, while in older patients lower levels of toxicity may be quite important. “Nevertheless, the DAFI CGA appears to have clinically useful potential.”