Mary M Mullen1, Tyler R McKinnish1, Mark A Fiala2, Abigail S Zamorano1, Lindsay M Kuroki1, Katherine C Fuh1, Andrea R Hagemann1, Carolyn K McCourt1, David G Mutch1, Matthew A Powell1, Tanya M Wildes3, Premal H Thaker4. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America. 2. Division of Oncology, Department of Medical Oncology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America; School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States of America. 3. Division of Oncology, Department of Medical Oncology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America. 4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America. Electronic address: thakerp@wustl.edu.
Abstract
OBJECTIVE: To determine the association between scores from a 25-item patient-reported Rockwood Accumulation of Deficits Frailty Index (DAFI) and survival outcomes in gynecologic cancer patients. METHODS: A frailty index was constructed from the SEER-MHOS database. The DAFI was applied to women age ≥ 65 diagnosed with all types of gynecologic cancers between 1998 and 2015. The impact of frailty status at cancer diagnosis on overall survival (OS) was analyzed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS: In this cohort (n = 1336) the median age at diagnosis was 74 (range 65-97). Nine hundred sixty-two (72%) women were Caucasian and 132 (10%) were African-American. Overall, 651(49%) of patients were considered frail. On multivariate analysis, frail patients had a 48% increased risk for death (aHR 1.48; 95% CI 1.29-1.69; P < 0.0001). Each 10% increase in frailty index was associated with a 16% increased risk of death (aHR, 1.16; 95% CI, 1.11 to 1.21; P < 0.0001). In subgroup analyses of the varying cancer types, the association of frailty status with prognosis was fairly consistent (aHR 1.15-2.24). The DAFI was more prognostic in endometrial (aHR 1.76; 95% CI 1.41-2.18, P < 0.0001) and vaginal/vulvar (aHR 1.94; 95% CI 1.34-2.81, P = 0.0005) cancers as well as patients with loco-regional disease (aHR 1.94; 95% CI 1.62-2.33, P < 0.0001). CONCLUSIONS: Frailty appears to be a significant predictor of mortality in gynecologic cancer patients regardless of chronological age. This measure of functional age may be of particular utility in women with loco-regional disease only who otherwise would have a favorable prognosis.
OBJECTIVE: To determine the association between scores from a 25-item patient-reported Rockwood Accumulation of Deficits Frailty Index (DAFI) and survival outcomes in gynecologic cancer patients. METHODS: A frailty index was constructed from the SEER-MHOS database. The DAFI was applied to women age ≥ 65 diagnosed with all types of gynecologic cancers between 1998 and 2015. The impact of frailty status at cancer diagnosis on overall survival (OS) was analyzed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS: In this cohort (n = 1336) the median age at diagnosis was 74 (range 65-97). Nine hundred sixty-two (72%) women were Caucasian and 132 (10%) were African-American. Overall, 651(49%) of patients were considered frail. On multivariate analysis, frail patients had a 48% increased risk for death (aHR 1.48; 95% CI 1.29-1.69; P < 0.0001). Each 10% increase in frailty index was associated with a 16% increased risk of death (aHR, 1.16; 95% CI, 1.11 to 1.21; P < 0.0001). In subgroup analyses of the varying cancer types, the association of frailty status with prognosis was fairly consistent (aHR 1.15-2.24). The DAFI was more prognostic in endometrial (aHR 1.76; 95% CI 1.41-2.18, P < 0.0001) and vaginal/vulvar (aHR 1.94; 95% CI 1.34-2.81, P = 0.0005) cancers as well as patients with loco-regional disease (aHR 1.94; 95% CI 1.62-2.33, P < 0.0001). CONCLUSIONS: Frailty appears to be a significant predictor of mortality in gynecologic cancer patients regardless of chronological age. This measure of functional age may be of particular utility in women with loco-regional disease only who otherwise would have a favorable prognosis.
Authors: Leocadio Rodríguez-Mañas; Catherine Féart; Giovanni Mann; Jose Viña; Somnath Chatterji; Wojtek Chodzko-Zajko; Magali Gonzalez-Colaço Harmand; Howard Bergman; Laure Carcaillon; Caroline Nicholson; Angelo Scuteri; Alan Sinclair; Martha Pelaez; Tischa Van der Cammen; François Beland; Jerome Bickenbach; Paul Delamarche; Luigi Ferrucci; Linda P Fried; Luis Miguel Gutiérrez-Robledo; Kenneth Rockwood; Fernando Rodríguez Artalejo; Gaetano Serviddio; Enrique Vega Journal: J Gerontol A Biol Sci Med Sci Date: 2012-04-16 Impact factor: 6.053
Authors: Lindsey A Torre; Britton Trabert; Carol E DeSantis; Kimberly D Miller; Goli Samimi; Carolyn D Runowicz; Mia M Gaudet; Ahmedin Jemal; Rebecca L Siegel Journal: CA Cancer J Clin Date: 2018-05-29 Impact factor: 508.702
Authors: Madeleine Courtney-Brooks; A Rauda Tellawi; Jennifer Scalici; Linda R Duska; Amir A Jazaeri; Susan C Modesitt; Leigh A Cantrell Journal: Gynecol Oncol Date: 2012-04-19 Impact factor: 5.482
Authors: Harvey Jay Cohen; David Smith; Can-Lan Sun; William Tew; Supriya G Mohile; Cynthia Owusu; Heidi D Klepin; Cary P Gross; Stuart M Lichtman; Ajeet Gajra; Julie Filo; Vani Katheria; Arti Hurria Journal: Cancer Date: 2016-08-16 Impact factor: 6.860
Authors: Thomas N Robinson; Ben Eiseman; Jeffrey I Wallace; Skotti D Church; Kim K McFann; Shirley M Pfister; Terra J Sharp; Marc Moss Journal: Ann Surg Date: 2009-09 Impact factor: 12.969
Authors: Brian J Buta; Jeremy D Walston; Job G Godino; Minsun Park; Rita R Kalyani; Qian-Li Xue; Karen Bandeen-Roche; Ravi Varadhan Journal: Ageing Res Rev Date: 2015-12-07 Impact factor: 10.895