Frailty index developed from a cancer-specific geriatric assessment and the association with mortality among older adults with cancer
Open accessAbstract
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.
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In oncology, frailty predicts treatment toxicity and mortality, and cancer societies recommend GA to assess frailty before treatment in older adults.
“In the oncology setting, frailty has been proven to predict toxicity from treatment and mortality, and leading cancer societies have recommended GA to gauge frailty prior to treatment in older adults to assess such risks [[28], [29], [30]].”
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- Authors
- Guerard, E. J., Deal, A. M., Chang, Y., Williams, G. R., Nyrop, K. A., Pergolotti, M., Muss, H. B., Sanoff, H. K., & Lund, J. L.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- ORCID
- Venue
- Journal of the National Comprehensive Cancer Network
- Publisher
- Harborside Press, LLC
- Published
- 2017-07
- Volume
- 15
- Issue
- 7
- Pages
- 894-902
- ISSN
- 1540-1405 (ISSN-L)
- 1540-1413
- OpenAlex
- W2725246371
- Cited by
- 168
- References
- 35
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 24 · 2023: 25 · 2022: 28 · 2021: 18 · 2020: 24 · 2019: 10 · 2018: 4 · 2017: 5
- FWCI
- 7.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the National Comprehensive Cancer Network (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- Breast Cancer Research Foundation
- National Institutes of Health (5k12ca120780-08)
- University of North Carolina at Chapel Hill
- National Cancer Institute (5K12CA120780, R25CA116339)
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- 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 index, frailty, elderly cancer patients, all-cause mortality, deficit accumulation, pre-frailty, mortality prediction, breast cancer, long-term survival
- MeSH terms
- Frailty, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Mortality, Neoplasms, North Carolina, Registries, Geriatric Assessment, Comorbidity, Frail Elderly
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