Frailty Markers and Treatment Decisions in Patients Seen in ă Oncogeriatric Clinics: Results from the ASRO Pilot Study
Résumé
Background ă Comprehensive Geriatric Assessment (CGA) is the gold standard to help ă oncologists select the best cancer treatment for their older patients. ă Some authors have suggested that the concept of frailty could be a more ă useful approach in this population. We investigated whether frailty ă markers are associated with treatment recommendations in an ă oncogeriatric clinic. ă Methods ă This prospective study included 70 years and older patients with solid ă tumors and referred for an oncogeriatric assessment. The CGA included ă nine domains: autonomy, comorbidities, medication, cognition, nutrition, ă mood, neurosensory deficits, falls, and social status. Five frailty ă markers were assessed (nutrition, physical activity, energy, mobility, ă and strength). Patients were categorized as Frail (three or more frailty ă markers), pre-frail (one or two frailty markers), or not-frail (no ă frailty marker). Treatment recommendations were classified into two ă categories: standard treatment with and without any changes and ă supportive/palliative care. Multiple logistic regression models were ă used to analyze factors associated with treatment recommendations. ă Results ă 217 patients, mean age 83 years (+/- Standard deviation (SD) 5.3), were ă included. In the univariate analysis, number of frailty markers, grip ă strength, physical activity, mobility, nutrition, energy, autonomy, ă depression, Eastern Cooperative Oncology Group Scale of Performance ă Status (ECOG-PS), and falls were significantly associated with final ă treatment recommendations. In the multivariate analysis, the number of ă frailty markers and basic Activities of Daily Living (ADL) were ă significantly associated with final treatment recommendations (p<0.001 ă and p = 0.010, respectively). ă Conclusion ă Frailty markers are associated with final treatment recommendations in ă older cancer patients. Longitudinal studies are warranted to better ă determine their use in a geriatric oncology setting.