The prevalence and outcomes of frailty in older cancer patients: a systematic review
Open accessAbstract
Background Frailty is a state of vulnerability to poor resolution of homeostasis following a stressor event, such as chemotherapy or cancer surgery. Better knowledge of the epidemiology of frailty could help drive a global cancer care strategy for older people. The aim of this review was to establish the prevalence and outcomes of frailty and pre-frailty in older cancer patients.Methods Observational studies that reported data on the prevalence and/or outcomes of frailty in older cancer patients with any stage of solid or haematological malignancy were considered. We searched Medline, CINAHL, Cochrane Library, EMBASE, Web of Science, Allied and Complementary medicine, Psychinfo and ProQuest (1 January 1996 to 30 June 2013). The primary outcomes were prevalence of frailty, treatment-related side-effects, unplanned hospitalization and mortality. Risk of bias was assessed using the Newcastle-Ottawa checklist.Results Data from 20 studies evaluating 2916 participants are included. The median reported prevalence of frailty and pre-frailty was 42% (range 6%-86%) and 43% (range 13%-79%), respectively. A median of 32% (range 11%-78%) of patients were classified as fit. Frailty was independently associated with increased all-cause mortality [adjusted 5-year hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.36-2.57]. There was evidence of increased risk of postoperative mortality for both frailty (adjusted 30-day HR 2.67, 95% CI 1.08-6.62) and pre-frailty (adjusted HR 2.33, 95% CI 1.20-4.52). Treatment complications were more frequent in those with frailty, including intolerance to cancer treatment (adjusted odds ratio 4.86, 95% CI 2.19-10.78) and postoperative complications (adjusted 30-day HR 3.19, 95% CI 1.68-6.04).Conclusions More than half of older cancer patients have pre-frailty or frailty and these patients are at increased risk of chemotherapy intolerance, postoperative complications and mortality. The findings of this review support routine assessment of frailty in older cancer patients to guide treatment decisions, and the development of multidisciplinary geriatric oncology services.
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A formal DAFI has not previously been applied to older cancer patients receiving chemotherapy.
“A formal Deficit Accumulation Frailty Index has not previously been applied to older cancer patients receiving chemotherapy.(19)”
From Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy (2016) · cites this paper as [19]
Clinicians and investigators find a summary measure useful for stratification and outcome prediction.
“Though the individual components of the CGA are needed to direct specific interventions, clinicians and investigators find having a summary measure useful for stratification and outcome prediction (19).”
From Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy (2016) · cites this paper as [19]
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- Authors
- Handforth, C., Clegg, A., Young, C., Simpkins, S., Seymour, M. T., Selby, P. J., & Young, J.
- Affiliations
- Leeds Teaching Hospitals NHS Trust (GB)
- University of Leeds (GB)
- Corresponding author
- Handforth, C.
- Venue
- Annals of Oncology
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 26
- Issue
- 6
- Pages
- 1091-1101
- ISSN
- 0923-7534 (ISSN-L)
- OpenAlex
- W2159230388
- Cited by
- 1,048
- References
- 43
- Citations by year
- 2026: 105 · 2025: 118 · 2024: 151 · 2023: 128 · 2022: 137 · 2021: 108 · 2020: 72 · 2019: 67 · 2018: 49 · 2017: 53 · 2016: 41 · 2015: 16 · 2014: 1 · 2012: 1
- FWCI
- 3.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of Oncology (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0509-10020)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- frailty, pre-frailty, elderly cancer patients, frailty prevalence, all-cause mortality, postoperative mortality, chemotherapy intolerance, treatment side effects, postoperative complications, frailty assessment, geriatric oncology, hematologic malignancies, solid tumors, multidisciplinary care, frailty screening, frailty interventions, quality of life, functional status
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Antineoplastic Agents, Female, Humans, Male, Neoplasms, Postoperative Complications, Predictive Value of Tests, Risk Factors, Geriatric Assessment, Comorbidity, Prevalence, Odds Ratio, Frail Elderly, Treatment Outcome
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