Emily J Guerard1,2, Allison M Deal3, YunKyung Chang3, Grant R Williams2,4, Kirsten A Nyrop2,3, Mackenzi Pergolotti3,5, Hyman B Muss2,3, Hanna K Sanoff2,3, Jennifer L Lund3,6. 1. Division of Hematology and Oncology, University of Wisconsin, Madison, Wisconsin 2. Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 3. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 4. Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama 5. Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado 6. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Abstract
Background: An objective measure is needed to identify frail older adults with cancer who are at increased risk for poor health outcomes. The primary objective of this study was to develop a frailty index from a cancer-specific geriatric assessment (GA) and evaluate its ability to predict all-cause mortality among older adults with cancer. Patients and Methods: Using a unique and novel data set that brings together GA data with cancer-specific and long-term mortality data, we developed the Carolina Frailty Index (CFI) from a cancer-specific GA based on the principles of deficit accumulation. CFI scores (range, 0-1) were categorized as robust (0-0.2), pre-frail (0.2-0.35), and frail (>0.35). The primary outcome for evaluating predictive validity was all-cause mortality. The Kaplan-Meier method and log-rank tests were used to compare survival between frailty groups, and Cox proportional hazards regression models were used to evaluate associations. Results: In our sample of 546 older adults with cancer, the median age was 72 years, 72% were women, 85% were white, and 47% had a breast cancer diagnosis. Overall, 58% of patients were robust, 24% were pre-frail, and 18% were frail. The estimated 5-year survival rate was 72% in robust patients, 58% in pre-frail patients, and 34% in frail patients (log-rank test, P<.0001). Frail patients had more than a 2-fold increased risk of all-cause mortality compared with robust patients (adjusted hazard ratio, 2.36; 95% CI, 1.51-3.68). Conclusions: The CFI was predictive of all-cause mortality in older adults with cancer, a finding that was independent of age, sex, cancer type and stage, and number of medical comorbidities. The CFI has the potential to become a tool that oncologists can use to objectively identify frailty in older adults with cancer.
Background: An objective measure is needed to identify frail older adults with cancer who are at increased risk for poor health outcomes. The primary objective of this study was to develop a frailty index from a cancer-specific geriatric assessment (GA) and evaluate its ability to predict all-cause mortality among older adults with cancer. Patients and Methods: Using a unique and novel data set that brings together GA data with cancer-specific and long-term mortality data, we developed the Carolina Frailty Index (CFI) from a cancer-specific GA based on the principles of deficit accumulation. CFI scores (range, 0-1) were categorized as robust (0-0.2), pre-frail (0.2-0.35), and frail (>0.35). The primary outcome for evaluating predictive validity was all-cause mortality. The Kaplan-Meier method and log-rank tests were used to compare survival between frailty groups, and Cox proportional hazards regression models were used to evaluate associations. Results: In our sample of 546 older adults with cancer, the median age was 72 years, 72% were women, 85% were white, and 47% had a breast cancer diagnosis. Overall, 58% of patients were robust, 24% were pre-frail, and 18% were frail. The estimated 5-year survival rate was 72% in robust patients, 58% in pre-frail patients, and 34% in frail patients (log-rank test, P<.0001). Frail patients had more than a 2-fold increased risk of all-cause mortality compared with robust patients (adjusted hazard ratio, 2.36; 95% CI, 1.51-3.68). Conclusions: The CFI was predictive of all-cause mortality in older adults with cancer, a finding that was independent of age, sex, cancer type and stage, and number of medical comorbidities. The CFI has the potential to become a tool that oncologists can use to objectively identify frailty in older adults with cancer.
Authors: Grant R Williams; Allison M Deal; Hyman B Muss; Marc S Weinberg; Hanna K Sanoff; Emily J Guerard; Kirsten A Nyrop; Mackenzi Pergolotti; Shlomit Strulov Shachar Journal: J Geriatr Oncol Date: 2017-08-24 Impact factor: 3.599
Authors: Grant R Williams; Mustafa Al-Obaidi; Chen Dai; Nabiel Mir; Sai Alekha Challa; Michael Daniel; Harita Patel; Brett Barlow; Crystal Young-Smith; Olumide Gbolahan; Ravi Paluri; Smita Bhatia; Smith Giri Journal: Cancer Date: 2020-09-04 Impact factor: 6.860
Authors: Grant R Williams; Mustafa Al-Obaidi; Chen Dai; Christian Harmon; Thomas W Buford; Olumide Gbolahan; Mackenzi Pergolotti; Smita Bhatia; Smith Giri Journal: Support Care Cancer Date: 2021-05-15 Impact factor: 3.603
Authors: Gabriel F P Aleixo; Seul Ki Choi; Alyssa J Tan; Kirsten A Nyrop; Alyson M Deal; William A Wood; Trevor A Jolly; Hyman B Muss Journal: Oncologist Date: 2019-09-13
Authors: Grant R Williams; Allison M Deal; Hanna K Sanoff; Kirsten A Nyrop; Emily J Guerard; Mackenzi Pergolotti; Shlomit S Shachar; Bryce B Reeve; Jeannette T Bensen; Seul Ki Choi; Hyman B Muss Journal: Support Care Cancer Date: 2018-11-27 Impact factor: 3.603
Authors: Melisa L Wong; Steven M Paul; Judy Mastick; Christine Ritchie; Michael A Steinman; Louise C Walter; Christine Miaskowski Journal: J Pain Symptom Manage Date: 2018-08-23 Impact factor: 3.612