학술논문
Assessing frailty in older Indian patients before cancer treatment: Comparative analysis of three scales and their implications for overall survival.
Document Type
Academic Journal
Author
Rao AR; Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India.; Noronha V; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Ramaswamy A; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Kumar A; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Pillai A; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Gattani S; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Sehgal A; Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India.; Kumar S; Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India.; Castelino R; Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India.; Pearce J; NIHR Acaemic Clinical Fellow in Medical Oncology, Leeds Institute of Medical Research at St James', University of Leeds, United Kingdom.; Dhekale R; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Jagtap P; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Tripathi V; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Satamkar S; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Krishnamurthy J; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Mahajan S; Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Daptardar A; Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Sonkusare L; Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Deodhar J; Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Ansari N; Department of Occupational therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Vagal M; Department of Occupational therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Mahajan P; Department of Digestive diseases and Clinical nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Timmanpyati S; Department of Digestive diseases and Clinical nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Nookala M; Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India.; Chitre A; Department of physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India.; Kapoor A; Department of Medical oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India.; Gota V; Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India.; Banavali S; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Badwe RA; Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.; Prabhash K; Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India. Electronic address: kumarprabhashtmh@gmail.com.
Source
Publisher: Elsevier Country of Publication: Netherlands NLM ID: 101534770 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-4076 (Electronic) Linking ISSN: 18794068 NLM ISO Abbreviation: J Geriatr Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Frailty, characterized by ageing-related vulnerability, influences outcomes in older adults. Our study aimed to investigate the relationship between frailty and clinical outcomes in older Indian patients with cancer.
Materials and Methods: Our observational single-centre study, conducted at Tata Memorial Hospital from February 2020 to July 2022, enrolled participants aged 60 years and above with cancer. Frailty was assessed using the Clinical Frailty Scale (CFS), G8, and Vulnerable Elders Survey (VES)-13. The primary objective was to explore the correlation between baseline frailty and overall survival. Statistical analyses include Kaplan-Meier, Cox proportional hazards, and Harrell's C test.
Results: A total of 1,177 patients (median age 68, 76.9% male) were evaluated in the geriatric oncology clinic. Common malignancies included lung (40.0%), gastrointestinal (35.8%), urological (11.9%), and head and neck (9.0%), with 56.5% having metastatic disease. Using CFS, G8, and VES-13 scales, 28.5%, 86.4%, and 38.0% were identified as frail, respectively. Median follow-up was 11.6 months, with 43.3% deaths. Patients fit on CFS (CFS 1-2) had a median survival of 28.02 months, pre-frail (CFS 3-4) 13.24 months, and frail (CFS ≥5) 7.79 months (p < 0.001). Abnormal G8 (≤14) and VES-13 (≥3) were associated with significantly lower median survival (p < 0.001). Multivariate analysis confirmed CFS's predictive power for mortality (p < 0.001), with hazard ratios [HRs] for pre-frail at 1.61(95% confidence interval [CI] 1.25 to 2.06) and frail at 2.31 (95%CI 1.74 to 3.05). G8 ≤ 14 had HR 2.00 (95%CI 1.42 to 2.83), and abnormal VES-13 had HR 1.36 (95%CI 1.11-1.67). In the likelihood ratio test, CFS significantly improved the model fit (p < 0.001). Harrell's C index for survival prediction was 0.62 for CFS, 0.54 for G8, and 0.58 for VES-13.
Discussion: In conclusion, our study highlights varying frailty prevalence and prognostic implications in older Indian patients with cancer, emphasizing the need for personalized care in oncology for this aging population. We would recommend using CFS as a tool to screen for frailty for older Indian patients with cancer.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Materials and Methods: Our observational single-centre study, conducted at Tata Memorial Hospital from February 2020 to July 2022, enrolled participants aged 60 years and above with cancer. Frailty was assessed using the Clinical Frailty Scale (CFS), G8, and Vulnerable Elders Survey (VES)-13. The primary objective was to explore the correlation between baseline frailty and overall survival. Statistical analyses include Kaplan-Meier, Cox proportional hazards, and Harrell's C test.
Results: A total of 1,177 patients (median age 68, 76.9% male) were evaluated in the geriatric oncology clinic. Common malignancies included lung (40.0%), gastrointestinal (35.8%), urological (11.9%), and head and neck (9.0%), with 56.5% having metastatic disease. Using CFS, G8, and VES-13 scales, 28.5%, 86.4%, and 38.0% were identified as frail, respectively. Median follow-up was 11.6 months, with 43.3% deaths. Patients fit on CFS (CFS 1-2) had a median survival of 28.02 months, pre-frail (CFS 3-4) 13.24 months, and frail (CFS ≥5) 7.79 months (p < 0.001). Abnormal G8 (≤14) and VES-13 (≥3) were associated with significantly lower median survival (p < 0.001). Multivariate analysis confirmed CFS's predictive power for mortality (p < 0.001), with hazard ratios [HRs] for pre-frail at 1.61(95% confidence interval [CI] 1.25 to 2.06) and frail at 2.31 (95%CI 1.74 to 3.05). G8 ≤ 14 had HR 2.00 (95%CI 1.42 to 2.83), and abnormal VES-13 had HR 1.36 (95%CI 1.11-1.67). In the likelihood ratio test, CFS significantly improved the model fit (p < 0.001). Harrell's C index for survival prediction was 0.62 for CFS, 0.54 for G8, and 0.58 for VES-13.
Discussion: In conclusion, our study highlights varying frailty prevalence and prognostic implications in older Indian patients with cancer, emphasizing the need for personalized care in oncology for this aging population. We would recommend using CFS as a tool to screen for frailty for older Indian patients with cancer.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)