A comparison of two pre-operative frailty measures in older surgical cancer patients

Kristjansson, Siri R.; Rønning, Benedicte; Hurria, Arti; Skovlund, Eva; Jordhøy, Marit S.; Nesbakken, Arild; Wyller, Torgeir B.

doi:10.1016/j.jgo.2011.09.002

« Previous Next »Journal of Geriatric Oncology
Volume 3, Issue 1 , Pages 1-7, January 2012

A comparison of two pre-operative frailty measures in older surgical cancer patients

Siri R. Kristjansson
- University of Oslo, Department of Geriatric Medicine, Oslo University Hospital — Ullevål, Oslo, Norway
- Corresponding author at: Department of Geriatric Medicine, Oslo University Hospital — Ullevål, 0424 Oslo, Norway. Tel.: +47 90787614; fax: +47 22118701.
Benedicte Rønning
- University of Oslo, Department of Geriatric Medicine, Oslo University Hospital — Ullevål, Oslo, Norway
Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA
- Department of Population Sciences, City of Hope, Duarte, CA 91010, USA
Eva Skovlund
- University of Oslo, School of Pharmacy, Oslo, Norway
Marit S. Jordhøy
- Department of Internal medicine, Innlandet Hospital Trust Hamar, Norway
- Regional Center of Excellence in Palliative Care, South-East Norway, Oslo University Hospital — Ullevål, Oslo, Norway
Arild Nesbakken
- University of Oslo, Surgical Department, Oslo University Hospital — Aker, Oslo, Norway
Torgeir B. Wyller
- University of Oslo, Department of Geriatric Medicine, Oslo University Hospital — Ullevål, Oslo, Norway

Received 21 June 2011; received in revised form 20 September 2011; accepted 30 September 2011. published online 14 November 2011.

Abstract

Background

Measuring frailty in older adults with cancer may identify patients with an increased risk of treatment complications. As it remains controversial how to identify frailty, the aim of this study was to compare a pre-operative multi-domain frailty measure based on a comprehensive geriatric assessment (CGA) to a modified version of the physical phenotype of frailty (PF) in a cohort of older adults with colorectal cancer, and to analyze the ability of the two classifications to predict post-operative complications and survival.

Methods

A prospective longitudinal study including 176 patients aged 70–94years electively operated for colorectal cancer in three Norwegian hospitals. A pre-operative CGA, self-reported quality of life, and measurements of grip strength and gait speed were performed. CGA-frailty was defined as fulfilling one or more of the following criteria: dependency in activities of daily living, severe comorbidity, cognitive dysfunction, depression, malnutrition, or >seven daily medications. PF was defined with three or more of the following criteria: unintentional weight loss, exhaustion, low physical activity, impaired grip strength, or slow gait speed. Outcome measures were post-operative complications and survival.

Results

The agreement between the classifications was poor. CGA-frailty was identified in 75 (43%) patients, while PF was identified in 22 (13%) patients. Only CGA-frailty predicted post-operative complications [P=0.001]. Both measures predicted survival.

Conclusions

A multi-domain frailty measure based on a CGA was more useful than frailty identified from a modified version of the PF criteria in predicting post-operative complications. For overall survival, both frailty measures were predictive.

Keywords: Geriatric assessment, Frailty, Geriatric oncology, Geriatric surgery, Pre-operative evaluation, Post-operative complications, Colorectal cancer, Surgical risk