Associations among frailty and quality of life in older patients with cancer treated with chemotherapy.

Previous studies have suggested that frailty among older adults with cancer is associated with a variety of negative outcomes, including greater chemotherapy toxicity and worse survival. However, results often do not include patient-reported outcomes, such as quality of life (QOL). The objective of this study was to evaluate frailty prior to receipt of moderately- or highly-emetogenic chemotherapy and acute changes in QOL in patients at least 65 years of age. It was hypothesized that frail patients would report greater declines in QOL. Participants completed questionnaires before receiving their first infusion and again five days later. A 59-item deficit accumulation index score was created at baseline using a modified Rockwood frailty index. QOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The relationship between baseline frailty and QOL was evaluated using a dichotomized deficit accumulation index (frail vs. robust) in repeated measures ANOVA. Study participants (n = 151) had a mean age of 72 (SD = 4.5) and 62% were female. Nearly half (42%) were frail at baseline. Frail participants reported worse QOL at baseline compared to robust participants. Frail patients reported smaller declines in overall and physical (p < 0.0001) and emotional (p = 0.006) QOL from baseline to five days after receiving chemotherapy. At five days, frail participants reported better emotional and physical QOL compared to robust participants. Contrary to expectations, frail patients reported smaller declines in QOL compared to robust patients using a deficit accumulation index. These results can be used to help educate frail patients on what to expect during treatment.

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Declaration of Competing Interest Dr. Jim is a consultant for Janssen Scientific Affairs and Merck. She has grant funding from Kite Pharma. Dr. Li reports research funding to his institution from AstraZeneca and Brooklyn ImmunoTherapeutics. He serves as a consultant and has received honoraria from Adagene, Advanced Accelerator Applications, Bayer Healthcare, Coherus BioSciences, Eisai, Exelixis, Genentech, Ipsen Biopharmaceuticals, Lexicon Pharmaceuticals, Merck, MiNA Therapeutics, QED Therapeutics, Servier, Sun Pharma, Taiho Pharmaceutical, and TerSera Therapeutics. Dr. Brownstein served as an ad-hoc grant reviewer in 2020 for the American Cancer Society, for which she received sponsored travel during the review meeting and a stipend of $300. She also received $500 from the Statistical Consulting Section of the American Statistical Association for Best Paper Award at the 2019 Joint Statistical Meetings. Dr. Brownstein serves as a member of the Scientific Review Committee at Moffitt Cancer Center.