Frailty screening for predicting rapid functional decline, rapid progressive disease, and shorter overall survival in older patients with gastrointestinal cancer receiving palliative chemotherapy - a prospective, clinical study

Eva Jespersen; Stine Braendegaard Winther; Lisbeth Rosenbek Minet; Sören Möller; Per Pfeiffer

doi:10.1016/j.jgo.2020.10.007

Frailty screening for predicting rapid functional decline, rapid progressive disease, and shorter overall survival in older patients with gastrointestinal cancer receiving palliative chemotherapy - a prospective, clinical study

J Geriatr Oncol. 2021 May;12(4):578-584. doi: 10.1016/j.jgo.2020.10.007. Epub 2020 Oct 21.

Authors

Eva Jespersen¹, Stine Braendegaard Winther², Lisbeth Rosenbek Minet³, Sören Möller⁴, Per Pfeiffer⁵

Affiliations

¹ Research Unit of Rehabilitation, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: eva.jespersen@rsyd.dk.
² Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
³ Research Unit of Rehabilitation, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Health Science Research Centre, UCL University College, Odense, Denmark.
⁴ OPEN - Open Patient Data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
⁵ Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark.

PMID: 33830020
DOI: 10.1016/j.jgo.2020.10.007

Abstract

Objectives: A growing number of older patients with cancer require well-founded clinical decision-making. Frailty screening is suggested as a service to improve outcomes in vulnerable older patients with cancer. This prospective study examined the value of frailty screening to predict rapid functional decline, rapid progressive disease (PD) and shorter overall survival (OS) in older patients with gastrointestinal cancer receiving palliative chemotherapy.

Materials and methods: Patients aged ≥70 years were screened for frailty in an oncologic department after clinical decision but before starting palliative chemotherapy. Screening was repeated at first response evaluation after approximately two months of chemotherapy. Frailty screening tools included performance status (PS), Charlson Comorbidity Index, G-8 using two different cut-offs (G8₁₄,G8₁₁), VES-13, Timed-Up-and-Go, Handgrip strength and falls.

Results: A total of 170 patients were included, median age was 75.5 (70-88) years and 65.9% were male. The frequency of frailty varied from 14% to 74% according to the chosen frailty tool. In multivariate analysis G8₁₄ predicted OS (HR 1.5; 95%CI 1.0-2.4), whereas G8₁₁ predicted PD (OR 2.4; 1.1-5.6) and OS (HR 2.1; 1.4-2.9). VES-13 predicted functional decline (OR 3.5; 1.0-11.6), PD (OR 3.5; 1.5-8.4) and OS (HR 1.7; 1.2-2.4). Timed-Up-and-Go predicted OS (HR 1.8; 1.1-2.7). Handgrip strength and falls predicted functional decline (OR 4.5; 1.1-19 and OR 6.1; 1.4-25.8, respectively). PS predicted PD (OR 6.2; 2.6-14.7) and OS (HR 2.2; 1.5-3.2).

Conclusion: VES-13 was useful for predicting all three endpoints of interest. Frailty tools covering domains of functioning and nutrition are suggested for older patients with advanced gastrointestinal cancer.

Keywords: Frailty screening; Gastrointestinal cancer; Older patients; Oncology; Palliative chemotherapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Early Detection of Cancer
Frail Elderly
Frailty* / diagnosis
Gastrointestinal Neoplasms* / drug therapy
Geriatric Assessment
Hand Strength
Humans
Male
Prospective Studies