Jane A Driver1, Akila N Viswanathan2. 1. Geriatric Research Education and Clinical Center, VA Boston Medical Center, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Dana-Farber Cancer Institute, Boston, MA, United States. Electronic address: jdriver@partners.org. 2. Brigham and Women's Hospital, Boston, MA, United States; Dana-Farber Cancer Institute, Boston, MA, United States; Johns Hopkins School of Medicine, Baltimore, MD, United States.
Abstract
OBJECTIVES: To determine if readily obtainable markers of frailty predict disease-free survival (DFS) in elderly women with endometrial cancer treated with curative intent. METHODS: 88 consecutive women≥age 60 treated with surgery, chemotherapy and radiation for stage I-IV endometrial cancer were included. We considered the following health deficits as markers of "frailty": albumin <3.5mg/dL, hemoglobin <10mg/dL, BMI<20kg/m,2 unintentional weight loss, ECOG performance status ≥2, history of osteopenia or osteoporosis and Charlson comorbidity score. Kaplan-Meier estimates and Cox proportional hazards models of DFS were calculated. RESULTS: The median age was 68.5 (range 60-88years). The majority of women (65/88) had at least one frailty factor at baseline and 23/88 had two or more. All women received radiation and chemotherapy. Treatment was delayed, modified or truncated in 46% (40/88) of women due to treatment-related toxicity. Age (< 70 vs. ≥70 y) did not independently predict toxicity or recurrence risk. Women with at least one baseline frailty factor had twice the risk of disease recurrence (HR=2.21;95% CI:1.02-4.80) when adjusted for age, stage, grade and Charlson score. The 3-year DFS was 77% in those with no frailty markers and 48% in those with at least one (p=0.02). The presence of a frailty marker also predicted shortened overall survival (HR=2.34;95% CI:1.08-5.03) irrespective of treatment administered and stage of disease. CONCLUSIONS: A combined frailty measure was a more robust predictor of DFS and OS than patient age, tumor characteristics and comorbidities in this cohort of older women with very good functional status. Published by Elsevier Inc.
OBJECTIVES: To determine if readily obtainable markers of frailty predict disease-free survival (DFS) in elderly women with endometrial cancer treated with curative intent. METHODS: 88 consecutive women≥age 60 treated with surgery, chemotherapy and radiation for stage I-IV endometrial cancer were included. We considered the following health deficits as markers of "frailty": albumin <3.5mg/dL, hemoglobin <10mg/dL, BMI<20kg/m,2 unintentional weight loss, ECOG performance status ≥2, history of osteopenia or osteoporosis and Charlson comorbidity score. Kaplan-Meier estimates and Cox proportional hazards models of DFS were calculated. RESULTS: The median age was 68.5 (range 60-88years). The majority of women (65/88) had at least one frailty factor at baseline and 23/88 had two or more. All women received radiation and chemotherapy. Treatment was delayed, modified or truncated in 46% (40/88) of women due to treatment-related toxicity. Age (< 70 vs. ≥70 y) did not independently predict toxicity or recurrence risk. Women with at least one baseline frailty factor had twice the risk of disease recurrence (HR=2.21;95% CI:1.02-4.80) when adjusted for age, stage, grade and Charlson score. The 3-year DFS was 77% in those with no frailty markers and 48% in those with at least one (p=0.02). The presence of a frailty marker also predicted shortened overall survival (HR=2.34;95% CI:1.08-5.03) irrespective of treatment administered and stage of disease. CONCLUSIONS: A combined frailty measure was a more robust predictor of DFS and OS than patient age, tumor characteristics and comorbidities in this cohort of older women with very good functional status. Published by Elsevier Inc.
Authors: Arti Hurria; Ilene S Browner; Harvey Jay Cohen; Crystal S Denlinger; Mollie deShazo; Martine Extermann; Apar Kishor P Ganti; Jimmie C Holland; Holly M Holmes; Mohana B Karlekar; Nancy L Keating; June McKoy; Bruno C Medeiros; Ewa Mrozek; Tracey O'Connor; Stephen H Petersdorf; Hope S Rugo; Rebecca A Silliman; William P Tew; Louise C Walter; Alva B Weir; Tanya Wildes Journal: J Natl Compr Canc Netw Date: 2012-02 Impact factor: 11.908
Authors: Mariam M AlHilli; Jamie N Bakkum-Gamez; Andrea Mariani; Amy L Weaver; Michaela E McGree; Gary L Keeney; Aminah Jatoi; Sean C Dowdy; Karl C Podratz Journal: Gynecol Oncol Date: 2015-04-17 Impact factor: 5.482
Authors: Carien L Creutzberg; Remi A Nout; Marnix L M Lybeert; Carla C Wárlám-Rodenhuis; Jan J Jobsen; Jan-Willem M Mens; Ludy C H W Lutgens; Elisabeth Pras; Lonneke V van de Poll-Franse; Wim L J van Putten Journal: Int J Radiat Oncol Biol Phys Date: 2011-06-02 Impact factor: 7.038
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Alexander E Sherman; Gabriela Motyckova; K Rebecca Fega; Daniel J Deangelo; Gregory A Abel; David Steensma; Martha Wadleigh; Richard M Stone; Jane A Driver Journal: Leuk Res Date: 2013-06-06 Impact factor: 3.156
Authors: J Alejandro Rauh-Hain; Kristen J Pepin; Larissa A Meyer; Joel T Clemmer; Karen H Lu; Laurel W Rice; Shitanshu Uppal; John O Schorge; Marcela G Del Carmen Journal: Obstet Gynecol Date: 2015-12 Impact factor: 7.661
Authors: Samuel D Searle; Arnold Mitnitski; Evelyne A Gahbauer; Thomas M Gill; Kenneth Rockwood Journal: BMC Geriatr Date: 2008-09-30 Impact factor: 3.921
Authors: Mary M Mullen; Tyler R McKinnish; Mark A Fiala; Abigail S Zamorano; Lindsay M Kuroki; Katherine C Fuh; Andrea R Hagemann; Carolyn K McCourt; David G Mutch; Matthew A Powell; Tanya M Wildes; Premal H Thaker Journal: Gynecol Oncol Date: 2021-02-26 Impact factor: 5.304
Authors: Sarah Nicole Hamilton; Anna V Tinker; Janice Kwon; Peter Lim; Iwa Kong; Sona Sihra; Martin Koebel; Cheng Han Lee Journal: J Gynecol Oncol Date: 2022-01-24 Impact factor: 4.756