A simple test-based frailty index to predict survival among cancer patients with an unplanned hospitalization: An observational cohort study.
frailty
hospital mortality
hospitalization
inpatients
patient readmission
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
revised:
28
05
2021
received:
19
03
2021
accepted:
04
06
2021
pubmed:
6
8
2021
medline:
4
3
2022
entrez:
5
8
2021
Statut:
ppublish
Résumé
Frailty is a state of increased vulnerability to stressors, and predicts risk of adverse outcomes, such as mortality. Frailty can be defined by a frailty index (FI) using an accumulation of deficits approach. An FI comprised of 20 items derived from our previously studied test-based frailty index (TBFI) and an additional 33 survey-based elements sourced from the standard CGA was developed to evaluate if predictive validity of survival was improved. One hundred eighty-nine cancer patients during acute hospitalization were consented between September 2018 and May 2019. Frailty scores were calculated, and patients were categorized into four groups: non-frail (0-0.2), mildly frail (0.2-0.3), moderately frail (0.3-0.4), and severely frail (>0.4). Patients were followed for 1-year to assess FI and TBFI prediction of survival. Area under the curve (AUC) statistics from ROC analyses were compared for the FI versus TBFI. Increasing frailty was similarly associated with increased risk of mortality (HR, 4.5 [95% CI, 2.519-8.075] and HR, 4.1 [95%CI, 1.692-9.942]) and the likelihood of death at 6 months was about 11-fold (odds ratio, 10.9 [95% CI, 3.97-33.24]) and 9.73-fold (95% CI, 2.85-38.50) higher for severely frail patients compared to non-frail patients for FI and TBFI, respectively. This association was independent of age and type of cancer. The FI and TBFI were predictive of survival for older and younger cancer patients with no significant differences between models in discriminating survival (FI AUC, 0.747 [95% CI, 0.6772-0.8157] and TBFI AUC, 0.724 [95% CI, 0.6513-0.7957]). The TBFI was predictive of survival, and the addition of an in-person assessment (FI) did not greatly improve predictive validity. Increasing frailty, as measured by a TBFI, resulted in a meaningfully increased risk of mortality and may be well-suited for screening of hospitalized cancer patients.
Sections du résumé
BACKGROUND
Frailty is a state of increased vulnerability to stressors, and predicts risk of adverse outcomes, such as mortality. Frailty can be defined by a frailty index (FI) using an accumulation of deficits approach. An FI comprised of 20 items derived from our previously studied test-based frailty index (TBFI) and an additional 33 survey-based elements sourced from the standard CGA was developed to evaluate if predictive validity of survival was improved.
METHODS
One hundred eighty-nine cancer patients during acute hospitalization were consented between September 2018 and May 2019. Frailty scores were calculated, and patients were categorized into four groups: non-frail (0-0.2), mildly frail (0.2-0.3), moderately frail (0.3-0.4), and severely frail (>0.4). Patients were followed for 1-year to assess FI and TBFI prediction of survival. Area under the curve (AUC) statistics from ROC analyses were compared for the FI versus TBFI.
RESULTS
Increasing frailty was similarly associated with increased risk of mortality (HR, 4.5 [95% CI, 2.519-8.075] and HR, 4.1 [95%CI, 1.692-9.942]) and the likelihood of death at 6 months was about 11-fold (odds ratio, 10.9 [95% CI, 3.97-33.24]) and 9.73-fold (95% CI, 2.85-38.50) higher for severely frail patients compared to non-frail patients for FI and TBFI, respectively. This association was independent of age and type of cancer. The FI and TBFI were predictive of survival for older and younger cancer patients with no significant differences between models in discriminating survival (FI AUC, 0.747 [95% CI, 0.6772-0.8157] and TBFI AUC, 0.724 [95% CI, 0.6513-0.7957]).
CONCLUSIONS
The TBFI was predictive of survival, and the addition of an in-person assessment (FI) did not greatly improve predictive validity. Increasing frailty, as measured by a TBFI, resulted in a meaningfully increased risk of mortality and may be well-suited for screening of hospitalized cancer patients.
Identifiants
pubmed: 34350715
doi: 10.1002/cam4.4107
pmc: PMC8419777
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
5765-5774Subventions
Organisme : NCI NIH HHS
ID : P30 CA076292
Pays : United States
Informations de copyright
© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
Cancer Med. 2021 Sep;10(17):5765-5774
pubmed: 34350715
Age Ageing. 2018 Jan 1;47(1):149-155
pubmed: 29206906
BMJ Support Palliat Care. 2019 Dec;9(4):413-424
pubmed: 31473652
BMC Geriatr. 2018 Jun 11;18(1):139
pubmed: 29898673
ScientificWorldJournal. 2001 Aug 08;1:323-36
pubmed: 12806071
Crit Rev Oncol Hematol. 2008 May;66(2):163-70
pubmed: 18243726
Cancer. 2016 Dec 15;122(24):3865-3872
pubmed: 27529755
BMC Med. 2018 Oct 26;16(1):188
pubmed: 30360759
Crit Rev Oncol Hematol. 2008 Apr;66(1):75-83
pubmed: 18164209
Eur J Intern Med. 2018 Oct;56:11-18
pubmed: 29907381
Gynecol Oncol. 2017 Oct;147(1):104-109
pubmed: 28734497
Age Ageing. 2016 Jul;45(4):463-8
pubmed: 27076524
Lancet Oncol. 2018 Jun;19(6):e305-e316
pubmed: 29893262
J Am Geriatr Soc. 2011 Oct;59(10):1837-46
pubmed: 22091497
BMC Med. 2014 Oct 07;12:171
pubmed: 25288274
Eur J Cancer Care (Engl). 2018 Mar;27(2):e12810
pubmed: 29337382
Palliat Med. 2000 Sep;14(5):363-74
pubmed: 11064783
Eur J Intern Med. 2016 Jun;31:3-10
pubmed: 27039014
PLoS One. 2019 Apr 29;14(4):e0216166
pubmed: 31034516
Soc Psychol Q. 2016 Dec;79(4):333-354
pubmed: 29038609
Clin Interv Aging. 2016 Apr 22;11:453-9
pubmed: 27217729
Age Ageing. 2015 May;44(3):471-7
pubmed: 25687601
J Natl Compr Canc Netw. 2017 Jul;15(7):894-902
pubmed: 28687577
Support Care Cancer. 2019 Jun;27(6):1973-1984
pubmed: 30863893
Mech Ageing Dev. 2019 Jun;180:107-116
pubmed: 31002924
Palliat Med. 2016 Jan;30(1):75-82
pubmed: 26376937
J Am Geriatr Soc. 2004 Nov;52(11):1929-33
pubmed: 15507074
Oncologist. 2020 Jun;25(6):488-496
pubmed: 31985125
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
pubmed: 11253156
Cancer Med. 2019 Nov;8(15):6503-6518
pubmed: 31493342
Tumori. 2014 Jan-Feb;100(1):91-6
pubmed: 24675498
J Gerontol A Biol Sci Med Sci. 2005 Jun;60(6):798-803
pubmed: 15983186
Oncologist. 2015 Jul;20(7):767-72
pubmed: 26032136
BMC Geriatr. 2008 Sep 30;8:24
pubmed: 18826625
Biometrics. 1988 Sep;44(3):837-45
pubmed: 3203132
Support Care Cancer. 2016 Mar;24(3):1079-89
pubmed: 26253587
J Am Med Dir Assoc. 2015 Oct 1;16(10):842-7
pubmed: 25952475
Clin Lung Cancer. 2017 Nov;18(6):660-666.e1
pubmed: 28320638
Palliat Med. 2007 Sep;21(6):487-92
pubmed: 17846088