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Sattar S, Haase KR, Lee K, Campbell KL. Exercise interventions for frail older adults with cancer. Curr Opin Support Palliat Care 2024; 18:22-26. [PMID: 38126248 DOI: 10.1097/spc.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW Frailty is prevalent in older adults with cancer and can lead to complications during cancer treatment and poor health outcomes. Exercise has been shown to be a promising strategy to mitigate frailty and slow the accumulation of functional impairment in the general geriatric population. In this review, we present a discussion on the state of the science of exercise interventions for frail older adults with cancer. This review is timely and relevant given the aging of the population and corresponding increase in proportion of older adults living with cancer. RECENT FINDINGS Existing research related to exercise interventions for frail older adults with cancer appear to show some promise in feasibility and efficacy in both surgical and systemic treatment settings. SUMMARY More research on this topic and testing rigorously structured exercise interventions for older adults with cancer may help inform cancer-specific guidelines and create a foundation of evidence to enable implementation of exercise interventions. These interventions can support cancer care to attenuate frailty-related outcomes while extending its benefit to overall health of this population.
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Affiliation(s)
- Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia
- BC Cancer Research Institute, Cancer Control
| | - Kayoung Lee
- Faculty of Applied Science, School of Nursing, University of British Columbia
| | - Kristin L Campbell
- BC Cancer Research Institute, Cancer Control
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Jia Y, Jiang Y, Fan X, Zhang Y, Li K, Wang H, Ning X, Yang X. Preoperative serum level of CA153 and a new model to predict the sub-optimal primary debulking surgery in patients with advanced epithelial ovarian cancer. World J Surg Oncol 2024; 22:64. [PMID: 38395933 PMCID: PMC10885626 DOI: 10.1186/s12957-024-03336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The aim of this study was to establish a preoperative model to predict the outcome of primary debulking surgery (PDS) for advanced ovarian cancer (AOC) patients by combing Suidan predictive model with HE4, CA125, CA153 and ROMA index. METHODS 76 AOC Patients in revised 2014 International Federation of Gynecology and Obstetrics (FIGO) stage III-IV who underwent PDS between 2017 and 2019 from Yunnan Cancer Hospital were included. Clinical data including the levels of preoperative serum HE4, CA125, CA153 and mid-lower abdominal CT-enhanced scan results were collected. The logistics regression analysis was performed to find factors associated with sub-optimal debulking surgery (SDS). The receiver operating characteristic curve was used to evaluate the predictive performances of selected variables in the outcome of primary debulking surgery. The predictive index value (PIV) model was constructed to predict the outcome of SDS. RESULTS Optimal surgical cytoreduction was achieved in 61.84% (47/76) patients. The value for CA125, HE4, CA153, ROMA index and Suidan score was lower in optimal debulking surgery (ODS) group than SDS group. Based on the Youden index, which is widely used for evaluating the performance of predictive models, the best cutoff point for the preoperative serum HE4, CA125, CA153, ROMA index and Suidan score to distinguish SDS were 431.55 pmol/l, 2277 KU/L, 57.19 KU/L, 97.525% and 2.5, respectively. Patients with PIV≥5 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing SDS were 73.7%, 82.9%, 62.9% and 72.3%, respectively. In the constructed model, the AUC of the SDS prediction was 0.770 (95% confidence interval: 0.654-0.887), P<0.001. CONCLUSION Preoperative serum CA153 level is an important non-invasive predictor of primary SDS in advanced AOC, which has not been reported before. The constructed PIV model based on Suidan's predictive model plus HE4, CA125, CA153 and ROMA index can noninvasively predict SDS in AOC patients, the accuracy of this prediction model still needs to be validated in future studies.
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Affiliation(s)
- Yue Jia
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Yaping Jiang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Xiaoqi Fan
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Ya Zhang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, Yunnan, P. R. China, 650118
| | - Kun Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, Yunnan, P. R. China, 650118
| | - Haohan Wang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Xianling Ning
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118
| | - Xielan Yang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, Yunnan, P. R. China, 650118.
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Chauhan S, Langstraat CL, Fought AJ, McGree ME, Cliby WA, Kumar A. Relationship between frailty and nutrition: Refining predictors of mortality after primary cytoreductive surgery for ovarian cancer. Gynecol Oncol 2024; 180:126-131. [PMID: 38091771 DOI: 10.1016/j.ygyno.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVE We aimed to examine the interplay between frailty and nutritional status on 90-day mortality after primary cytoreductive surgery (PCS) for ovarian cancer (OC). METHODS Patients with OC who underwent PCS from 1/2/2006-4/30/2018 at a single institution were identified. Frailty index (FI) includes 30 items and is calculated summing across all the item scores and dividing by the total; frailty was defined as FI ≥0.15. Nutritional status was considered impaired when preoperative serum albumin was <3.5 g/dL. Logistic regression was used to analyze the association between FI (continuous) and albumin status (binary) and 90-day postoperative mortality. RESULTS A total of 533 patients (mean age, 64.4 years) were included, the majority were stage IIIC disease and serous histology. Albumin was <3.5 g/dL in 87 patients (16.3%) and 113 patients (21.2%) were considered frail. Median FI was 0.07 (IQR 0.03, 0.13). Postoperative 90-day mortality occurred in 24 patients (4.5%). Mortality within 90 days was higher amongst patients with low albumin (12/87, 13.8%), regardless of frailty status (13.8% [9/65] non-frail and 13.6% [3/22] frail patients). Ninety-day mortality in patients with normal albumin (n = 446) was over twice as likely in frail versus non-frail patients (5.5% [5/91] vs. 2.0% [7/355], respectively, p = 0.08). A model to assess 90-day mortality that included both FI and low albumin significantly improved the overall discrimination compared to low albumin alone (AUC 0.76 vs. 0.68 p = 0.03). CONCLUSION Our findings suggest that frailty and nutrition are both related to 90-day mortality. Preoperative interventions to improve functional and nutritional characteristics are needed.
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Affiliation(s)
- Shruti Chauhan
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Angela J Fought
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
| | - Michaela E McGree
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
| | - William A Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
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Shah R, Polen-De C, McGree M, Fought A, Kumar A. Re-Evaluating Chemotherapy Dosing Strategies for Ovarian Cancer: Impact of Sarcopenia. Curr Oncol 2023; 30:9501-9513. [PMID: 37999108 PMCID: PMC10670337 DOI: 10.3390/curroncol30110688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
We investigated the impact of sarcopenia on adjuvant chemotherapy dosing in advanced epithelial ovarian cancer (EOC). The chemotherapy dosing and toxicity of 173 eligible patients who underwent cytoreductive surgery and adjuvant chemotherapy at a single institution were analyzed. Patients with a skeletal muscle index less than 39 cm2/m2 measured on a CT scan were considered sarcopenic. Sarcopenic and non-sarcopenic patients were compared with regard to relative dose intensity (RDI), completion of scheduled chemotherapy, toxicity, and survival. A total of 62 (35.8%) women were sarcopenic. Sarcopenic women were less likely to complete at least six cycles of chemotherapy (83.9% vs. 95.5%, p = 0.02). The mean RDI for both carboplatin (80.4% vs. 89.4%, p = 0.03) and paclitaxel (91.9% vs. 104.1%, p = 0.03) was lower in sarcopenic patients compared to non-sarcopenic patients. Despite these differences in chemotherapy, there was no difference in neutropenia or median overall survival (3.99 vs. 4.57 years, p = 0.62) between the sarcopenic and non-sarcopenic women, respectively. This study highlights the importance of considering lean body mass instead of body weight or surface area in chemotherapy dosing formulas for sarcopenic women with advanced EOC. Further research is needed to optimize chemotherapy strategies based on individual body composition, potentially leading to improved dosing strategies in this population.
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Affiliation(s)
- Rushi Shah
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Clarissa Polen-De
- Department of Gynecologic Oncology, Summa Health, Akron, OH 44304, USA;
| | - Michaela McGree
- Department of Quantitative Health Sciences, Division Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55905, USA; (M.M.); (A.F.)
| | - Angela Fought
- Department of Quantitative Health Sciences, Division Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55905, USA; (M.M.); (A.F.)
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecological Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Ferrero A, Massobrio R, Villa M, Badellino E, Sanjinez JOSP, Giorgi M, Testi A, Govone F, Attianese D, Biglia N. Development and clinical application of a tool to identify frailty in elderly patients with gynecological cancers. Int J Gynecol Cancer 2023:ijgc-2023-004306. [PMID: 37487663 DOI: 10.1136/ijgc-2023-004306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE Frailty is more reliable than chronological age in predicting the effectiveness and tolerability of treatments in cancer patients. An increasing number of screening tools have been proposed, however none have received unanimous consent or been specifically designed for women with gynecological malignancies.This study's aim was to develop a clinical application of a screening tool to identify frail patients >70 years old diagnosed with either ovarian or endometrial cancers. METHODS A 20 item questionnaire was developed and administered to the cohort before surgery or neoadjuvant chemotherapy. A cut-off for frailty definition was determined by analyzing the correlation of questionnaire scores with the completion of treatments. The association between frailty and treatment related complications was assessed using a Chi-squared test for categorical variables and a t-test for continuous variables. RESULTS Our study included 100 patients, 50% diagnosed with endometrial cancer and 50% with ovarian cancer. A questionnaire score of 4 was the best cut-off for frailty definition (sensitivity 77%, specificity 100%). Surgical grade III and grade IV complications were observed only in frail patients (p=0.01) and hospitalization was significantly longer in frail women affected by ovarian cancer (p=0.01). Frail patients were more exposed to chemotherapy administration delay (p=0.0005), treatment discontinuation (p=0.001) and hematological toxicities, especially anemia ≥grade 2 (p=0.009) and thrombocytopenia any grade (p=0.0001). CONCLUSION With a cut-off score of 4, our tool can identify frail patients with significantly higher incidence of grade III-IV postoperative complications, length of stay, medical treatment discontinuation rates and hematological toxicities.
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Affiliation(s)
- Annamaria Ferrero
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Roberta Massobrio
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Michela Villa
- Division of Gynecology and Obstetrics, Ospedale Cardinal Massaia di Asti, Asti, Piemonte, Italy
| | - Enrico Badellino
- Division of Gynecology and Obstetrics, Ospedale Cardinal Massaia di Asti, Asti, Piemonte, Italy
| | - Jeremy Oscar Smith Pezua Sanjinez
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Margherita Giorgi
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Alessandra Testi
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Francesca Govone
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Daniela Attianese
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Nicoletta Biglia
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
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Strang P, Schultz T. The Impact of Frailty on Palliative Care Receipt, Emergency Room Visits and Hospital Deaths in Cancer Patients: A Registry-Based Study. Curr Oncol 2023; 30:6623-6633. [PMID: 37504346 PMCID: PMC10378432 DOI: 10.3390/curroncol30070486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients. METHOD Hospital Frailty Risk Scores (HFRS) were calculated based on 109 weighted International Classification of Diseases 10th revision (ICD-10) diagnoses, and HFRS was related to (a) receipt of specialized palliative care, (b) unplanned emergency room (ER) visits during the last month of life, and (c) acute hospital deaths. RESULTS A total of 20,431 deceased cancer patients in ordinary accommodations were studied (nursing home residents were excluded). Frailty, as defined by the HFRS, was more common in men than in women (42% vs. 38%, p < 0.001) and in people residing in less affluent residential areas (42% vs. 39%, p < 0.001). Patients with frailty were older (74.1 years vs. 70.4 years, p < 0.001). They received specialized palliative care (SPC) less often (76% vs. 81%, p < 0.001) but had more unplanned ER visits (50% vs. 35%, p < 0.001), and died more often in acute hospital settings (22% vs. 15%, p < 0.001). In multiple logistic regression models, the odds ratio (OR) was higher for frail people concerning ER visits (OR 1.81 (1.71-1.92), p < 0.001) and hospital deaths (OR 1.66 (1.51-1.81), p < 0.001), also in adjusted models, when controlled for age, sex, socioeconomic status at the area level, and for receipt of SPC. CONCLUSION Frailty, as measured by the HFRS, significantly affects end-of-life cancer patients and should be considered in oncologic decision-making.
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Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
- Research and Development Department, Stockholm's Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
| | - Torbjörn Schultz
- Research and Development Department, Stockholm's Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
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Fletcher JA, Logan B, Reid N, Gordon EH, Ladwa R, Hubbard RE. How frail is frail in oncology studies? A scoping review. BMC Cancer 2023; 23:498. [PMID: 37268891 DOI: 10.1186/s12885-023-10933-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 05/08/2023] [Indexed: 06/04/2023] Open
Abstract
AIMS The frailty index (FI) is one way in which frailty can be quantified. While it is measured as a continuous variable, various cut-off points have been used to categorise older adults as frail or non-frail, and these have largely been validated in the acute care or community settings for older adults without cancer. This review aimed to explore which FI categories have been applied to older adults with cancer and to determine why these categories were selected by study authors. METHODS This scoping review searched Medline, EMBASE, Cochrane, CINAHL, and Web of Science databases for studies which measured and categorised an FI in adults with cancer. Of the 1994 screened, 41 were eligible for inclusion. Data including oncological setting, FI categories, and the references or rationale for categorisation were extracted and analysed. RESULTS The FI score used to categorise participants as frail ranged from 0.06 to 0.35, with 0.35 being the most frequently used, followed by 0.25 and 0.20. The rationale for FI categories was provided in most studies but was not always relevant. Three of the included studies using an FI > 0.35 to define frailty were frequently referenced as the rationale for subsequent studies, however, the original rationale for this categorisation was unclear. Few studies sought to determine or validate optimum FI categorises in this population. CONCLUSION There is significant variability in how studies have categorised the FI in older adults with cancer. An FI ≥ 0.35 to categorise frailty was used most frequently, however an FI in this range has often represented at least moderate to severe frailty in other highly-cited studies. These findings contrast with a scoping review of highly-cited studies categorising FI in older adults without cancer, where an FI ≥ 0.25 was most common. Maintaining the FI as a continuous variable is likely to be beneficial until further validation studies determine optimum FI categories in this population. Differences in how the FI has been categorised, and indeed how older adults have been labelled as 'frail', limits our ability to synthesise results and to understand the impact of frailty in cancer care.
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Affiliation(s)
- James A Fletcher
- Division of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.
- Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - Benignus Logan
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - Natasha Reid
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - Emily H Gordon
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - Rahul Ladwa
- Division of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
- Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
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Goede V. Frailty and Cancer: Current Perspectives on Assessment and Monitoring. Clin Interv Aging 2023; 18:505-521. [PMID: 37013130 PMCID: PMC10066705 DOI: 10.2147/cia.s365494] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/12/2023] [Indexed: 03/30/2023] Open
Abstract
Frailty, an age-related condition of increased vulnerability to acute endogenous or exogenous stressors, is a key barrier to successful treatment of cancer in older people. In this group of patients, assessment of frailty is required before starting a new treatment. According to guidelines, the gold standard to assess frailty in older adults with cancer is geriatric screening followed by geriatric assessment (GA) across essential GA-domains (social status, physical function, nutrition, cognition, emotion, co-morbidity, polypharmacy). GA enables tailoring of both oncological therapy and non-oncological interventions to the patient's vulnerabilities. Large clinical trials recently have demonstrated that the feasibility and tolerability of systemic cancer treatment in older patients are significantly improved by such GA-guided management. Indications and optimal tools for frailty monitoring during the course of cancer treatment have not yet been defined in greater detail. New technologies such as wearable sensors or apps offer promising new opportunities to further develop frailty monitoring. This review describes the current standards and perspectives for the assessment and monitoring of frailty in elderly patients with cancer.
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Affiliation(s)
- Valentin Goede
- Department of Oncogeriatrics, Center of Geriatric Medicine, St. Marien-Hospital, Cologne, Germany
- Correspondence: Valentin Goede, Department of Oncogeriatrics, Center of Geriatric Medicine, St. Marien-Hospital, Kunibertskloster 11-13, Cologne, 50668, Germany, Tel +49 221 1629 2311, Fax +49 221 1629 2306, Email
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Ramos SZ, Kulkarni A, Oliver M, Danilack VA, Mathews C. Frailty as a predictor of delayed initiation of adjuvant chemotherapy in patients with ovarian cancer. Int J Gynecol Cancer 2023; 33:57-65. [PMID: 36423959 DOI: 10.1136/ijgc-2022-003603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to identify whether frailty is associated with the time between surgery and the initiation of chemotherapy for patients with ovarian cancer. METHODS This retrospective cohort study included patients 18 years or older with stage II to IV ovarian cancer who underwent primary debulking surgery at a tertiary medical center between July 2006 and July 2015. Basic demographics and clinical information were obtained from a departmental database and the electronic medical record. The Modified Frailty Index (mFI) was calculated based on 10 comorbidities and functional status yielding 11 items total. Patients were categorized by a total score: 0-1=no frailty, 2=moderate frailty and 3+=high frailty. RESULTS Among 451 patients, 359 had mFI scores of 0-1, 60 had a score of 2, and 32 had scores of 3+. Mean time from surgery to initiation of chemotherapy was 37 days. Mean number of days between surgery and initiation of chemotherapy increased with increasing frailty score: 36 days for the not frail group, 39 days for the moderate frailty group, and 54 days for the high frailty group (p<0.001). Time to initiation of chemotherapy of 42 days or more occurred in 23% of the no frailty group, 28% in the moderate frailty group, and 63% in the high frailty group (p<0.001). Overall survival decreased with increasing frailty scores. CONCLUSION High mFI scores lead to a greater delay between surgery and chemotherapy initiation. Being able to predict delays in initiation of chemotherapy may allow oncologists to consider neoadjuvant chemotherapy, pre-habilitation before surgery, and improved preoperative counseling in high-risk patients.
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Affiliation(s)
- Sebastian Z Ramos
- Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Amita Kulkarni
- Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Matthew Oliver
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Valery A Danilack
- Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Cara Mathews
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
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Li K, Yin R, Li Z. Frailty and long-term survival of patients with ovarian cancer: A systematic review and meta-analysis. Front Oncol 2022; 12:1007834. [PMID: 36324564 PMCID: PMC9618815 DOI: 10.3389/fonc.2022.1007834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/20/2022] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Frailty has been related with poor prognosis of various diseases, including ovarian cancer. We performed a systematic review and meta-analysis to evaluate the association between frailty and long-term survival of patients with ovarian cancer. METHODS Relevant cohort studies were retrieved by search of PubMed, Embase, Cochrane's Library, and Web of Science electronic databases. Two authors independently performed literature search, data collection, and statistical analyses. A random-effect model incorporating the possible influence of heterogeneity was used to pool the results. RESULTS Nine cohort studies including 2497 women with confirmed diagnosis of ovarian cancer contributed to the meta-analysis, and 536 (21.5%) of them were with high frailty. The median follow-up durations varied between 24 and 69 months. Compared to patients with low or non-frailty, OC patients with high frailty were associated with poor overall survival (risk ratio [RR]: 1.61, 95% confidence interval [CI]: 1.41 to 1.85, p < 0.001; I2 = 0%) and progression-free survival (RR: 1.51, 95% CI: 1.20 to 1.89, p < 0.001; I2 = 0%). Subgroup analyses according to study design, cancer stage, age of patients, scales for frailty evaluation, follow-up duration, and quality score of the included study showed consistent association between high frailty and poor overall survival in women with ovarian cancer (p for subgroup effects all < 0.05). After considering GRADE criteria for strength of the evidence, it was rated low for both the two outcomes. CONCLUSION High frailty may be an independent risk factor of poor survival in women with ovarian cancer. Evaluating frailty may be important for predicting the prognosis and determining the optimal anticancer treatments in women with ovarian cancer. SYSTEMATIC REVIEW REGISTRATION https://inplasy.com/, identifier INPLASY202290028.
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Affiliation(s)
| | | | - Zhengyu Li
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China
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AlHilli MM, Schold JD, Kelley J, Tang AS, Michener CM. Preoperative assessment using the five-factor modified frailty index: A call for standardized preoperative assessment and prehabilitation services in gynecologic oncology. Gynecol Oncol 2022; 166:379-388. [PMID: 35863992 DOI: 10.1016/j.ygyno.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/26/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate if the 5-factor modified frailty index (mFI) is associated with postoperative complications, readmissions or non-home discharge in gynecologic cancer patients undergoing surgery. METHODS Patients with a diagnosis of gynecologic cancer (cervical, uterine, or ovarian cancer) who underwent surgery between 2014 and 2018 were identified through the National Surgical Quality Improvement Program (NSQIP) database. The 5-factor mFI was applied and patients classified into 6 categories (mFI groups 0,1,2, 3, 4 and 5). The incidence of 30-day complications, readmissions and non-home discharge was evaluated. Multivariable logistic regression models were used to determine the association between mFI category and readmissions/ complications. Adjusted probabilities of events were calculated based on patient characteristics. RESULTS At total of 31,181 gynecologic cancer cases were included in the analysis: N = 2968 (9.4%) cervical, N = 20,862 (66.4%) uterine, and N = 7351 (23.4%) ovarian cancers. Of all patients, 46.1% were in category 0, 36.5% category 1, and 1% category 3-5. Factors associated with increased mFI included older age, African American race, laparoscopic surgery and obesity. A significant dose-response relationship between higher mFI and readmission and 30-day complications was noted on adjusted multivariable analysis (adjusted OR 2.37 (1.65-3.45) and 2.10 (1.59-2.75) for readmissions and complications, respectively, in mFI category 3-5). These associations were consistent within each cancer type. CONCLUSIONS The 5-factor mFI universally predicts postoperative readmissions, 30-day complications and non-home discharge in patients with gynecologic cancer. Incorporation of mFI into routine preoperative assessment can identify patients for non-surgical treatments, prehabiliatation and short term home assessments.
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Affiliation(s)
- Mariam M AlHilli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH, USA.
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA; Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Johanna Kelley
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Anne S Tang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA; Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chad M Michener
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH, USA
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Chao CT, Lee SY, Wang J, Chien KL, Huang JW. Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease. BMC Geriatr 2021; 21:349. [PMID: 34098883 PMCID: PMC8186134 DOI: 10.1186/s12877-021-02299-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background Patients with diabetic mellitus (DM) and chronic kidney disease (CKD) are at an increased risk of urinary tract infection (UTI) due to their altered immunological integrity. These patients are similarly prone to developing frailty, a state of cumulative health deficits involving multiple domains and leading to adverse outcomes. Whether frailty predisposes affected individuals to UTI among patients with DM and CKD remains unclear. Methods A population-based cohort of patients with DM and CKD (n = 79,887) were assembled from the Longitudinal Cohort of Diabetes Patients, with their baseline frailty status measured by a modified FRAIL scale. We analyzed their risk of developing UTI depending on their severity of frailty, after accounting demographic profiles, lifestyle factors, comorbidities, concurrent medications, and major interventions. A secondary analysis focused on the risk of urosepsis related to frailty. Results Among all participants, 36.1 %, 50.3 %, 12.8 %, and 0.8 % did not have or had 1, 2, and ≥ 3 FRAIL items, respectively, at baseline. After 3.51 years, 11,175 UTI events occurred. Kaplan-Meier analysis showed that participants with DM, CKD and an increasing number of FRAIL items had successively higher incidence of UTI than those without any FRAIL items (log rank p < 0.001). Cox proportional hazard modeling revealed that after accounting for all confounders, those with more severe frailty exhibited a significantly higher risk of incident UTI (for groups of 1, 2, and ≥ 3 FRAIL items, hazard ratio 1.19, 1.24, and 1.43, respectively; all p < 0.001) than those without. An 11 % risk elevation for UTI could be observed for every FRAIL item increase. Participants with more severe frailty exhibited a trend of having higher risk of urosepsis as well. Conclusions Having frailty predicted a higher risk of developing UTI in the future in patients with DM and CKD. It would be prudent to screen for frailty in these patients and provide optimal frailty-directed management to attenuate their risk of UTI and improve their outcomes.
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Affiliation(s)
- Chia-Ter Chao
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Ying Lee
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin county, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin county, Taiwan.
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13
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Chao CT, Lee SY, Wang J, Chien KL, Huang JW. Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease. BMC Geriatr 2021. [PMID: 34098883 DOI: 10.1186/s12877-021-02299-3[publishedonlinefirst:2021/06/09]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Patients with diabetic mellitus (DM) and chronic kidney disease (CKD) are at an increased risk of urinary tract infection (UTI) due to their altered immunological integrity. These patients are similarly prone to developing frailty, a state of cumulative health deficits involving multiple domains and leading to adverse outcomes. Whether frailty predisposes affected individuals to UTI among patients with DM and CKD remains unclear. METHODS A population-based cohort of patients with DM and CKD (n = 79,887) were assembled from the Longitudinal Cohort of Diabetes Patients, with their baseline frailty status measured by a modified FRAIL scale. We analyzed their risk of developing UTI depending on their severity of frailty, after accounting demographic profiles, lifestyle factors, comorbidities, concurrent medications, and major interventions. A secondary analysis focused on the risk of urosepsis related to frailty. RESULTS Among all participants, 36.1 %, 50.3 %, 12.8 %, and 0.8 % did not have or had 1, 2, and ≥ 3 FRAIL items, respectively, at baseline. After 3.51 years, 11,175 UTI events occurred. Kaplan-Meier analysis showed that participants with DM, CKD and an increasing number of FRAIL items had successively higher incidence of UTI than those without any FRAIL items (log rank p < 0.001). Cox proportional hazard modeling revealed that after accounting for all confounders, those with more severe frailty exhibited a significantly higher risk of incident UTI (for groups of 1, 2, and ≥ 3 FRAIL items, hazard ratio 1.19, 1.24, and 1.43, respectively; all p < 0.001) than those without. An 11 % risk elevation for UTI could be observed for every FRAIL item increase. Participants with more severe frailty exhibited a trend of having higher risk of urosepsis as well. CONCLUSIONS Having frailty predicted a higher risk of developing UTI in the future in patients with DM and CKD. It would be prudent to screen for frailty in these patients and provide optimal frailty-directed management to attenuate their risk of UTI and improve their outcomes.
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Affiliation(s)
- Chia-Ter Chao
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Ying Lee
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin county, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin county, Taiwan.
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Chambers LM, Chalif J, Yao M, Chichura A, Morton M, Gruner M, Costales AB, Horowitz M, Chau DB, Vargas R, Rose PG, Michener CM, Debernardo R. Modified frailty index predicts postoperative complications in women with gynecologic cancer undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Gynecol Oncol 2021; 162:368-374. [PMID: 34083027 DOI: 10.1016/j.ygyno.2021.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/15/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE(S) To evaluate the impact of frailty on postoperative complications following cytoreductive surgery (CRS) with hyperthermic intra-peritoneal chemotherapy (HIPEC) in women with advanced or recurrent gynecologic cancer. METHODS An IRB-approved single-institution prospective registry was queried for women who underwent CRS with HIPEC for advanced or recurrent gynecologic cancer from 1/1/2014-12/31/2020. Frailty was defined as a modified Frailty Index (mFI) score of ≥2. Logistic regression was used to assess the impact of mFI upon the rate of moderate or higher (≥ grade 2) Accordion postoperative complications. RESULTS Of 141 women, 81.6% (n = 115) were non-frail with mFI of 0-1 and 18.4% (n = 26) were frail with mFI ≥2. The incidence of ≥ grade 2 complications was 21.2% (n = 14) for mFI = 0, 26.5% (n = 13) for mFI = 1, 64.7% (n = 11) for mFI = 2 and 100.0% (n = 9) for patients with mFI ≥3. The incidence of re-operation (1.7% vs. 11.5%, p = 0.044), ICU admission (13.2% vs. 34.6%, p = 0.018), acute kidney injury (6.3% vs. 30.8%, p = 0.001), and respiratory failure (0.9% vs. 19.2%, p < 0.001) were significantly lower amongst non-frail vs. frail women. On multivariable analysis, mFI ≥2 was associated with significantly increased ≥ grade 2 complications versus mFI of 0-1 (OR 9.4, 95% CI 3.3, 26.4, p < 0.001). Age (OR 1.04, 95% CI 1.00, 1.09, p = 0.07), surgical indication (recurrent vs. primary) (OR 0.71, 95% CI 0.30, 1.7, p = 0.44) and Surgical Complexity Score of Intermediate or High vs. Low (OR 1.5, 95% CI 0.67, 3.5, p = 0.31) were not associated with ≥grade 2 complications. CONCLUSIONS Frailty, defined by the modified frailty index, is predictive of ≥grade 2 postoperative complications following CRS with HIPEC in women with gynecologic cancer. Frailty screening before CRS with HIPEC may assist patient selection and improve postoperative outcomes.
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Affiliation(s)
- Laura M Chambers
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| | - Julia Chalif
- Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Meng Yao
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Anna Chichura
- Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Molly Morton
- Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Morgan Gruner
- Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Anthony B Costales
- Department of Gynecologic Oncology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Max Horowitz
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Danielle B Chau
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Roberto Vargas
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Peter G Rose
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Chad M Michener
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robert Debernardo
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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