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Frailty as determined by a comprehensive geriatric assessment‐derived deficit‐accumulation index in older patients with cancer who receive chemotherapy
Author(s) -
Cohen Harvey Jay,
Smith David,
Sun CanLan,
Tew William,
Mohile Supriya G.,
Owusu Cynthia,
Klepin Heidi D.,
Gross Cary P.,
Lichtman Stuart M.,
Gajra Ajeet,
Filo Julie,
Katheria Vani,
Hurria Arti
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30269
Subject(s) - medicine , geriatric oncology , cutoff , toxicity , chemotherapy , cancer , frailty index , population , gerontology , physical therapy , physics , environmental health , quantum mechanics
BACKGROUND Frailty has been suggested as a construct for oncologists to consider in treating older cancer patients. Therefore, the authors assessed the potential of creating a deficit‐accumulation frailty index (DAFI) from a largely self‐administered comprehensive geriatric assessment (CGA). METHODS Five hundred patients aged ≥65 years underwent a CGA before receiving chemotherapy. A DAFI was constructed, resulting in a 51‐item scale, and cutoff values were examined for patients in the robust/nonfrail (cutoff value, 0.0 < 0.2), prefrail (cutoff value, 0.2 < 0.35), and frail (cutoff value, ≥ 0.35) groups. RESULTS Two hundred and fifty patients (50%) were nonfrail, 197 (39%) were prefrail, and 52 (11%) were frail. Older patients (aged ≥ 80 years) and those who had lower education, were living alone, and had higher stage disease were associated with prefrail/frail status. Prefrail/frail patients were more likely to have grade ≥3 toxicity but not to have a dose delay or reduction, and they were more likely to discontinue drug and be hospitalized. The association with grade ≥3 toxicity was attenuated by controlling for a toxicity risk calculator, but the other outcomes were not. CONCLUSIONS A deficit‐accumulation frailty index can be constructed from a CGA in older patients with cancer and can indicate the frailty status of the population. The frailty status so determined is associated both with outcomes likely because of chemotherapy toxicity and with those likely because of age‐related physiologic and functional deficits and thus can be useful in the overall assessment of the patient. Cancer 2016;122:3865–3872. © 2016 American Cancer Society.