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. Author manuscript; available in PMC: 2021 Jul 1.
Published in final edited form as: Transl Res. 2020 May 1;221:65–82. doi: 10.1016/j.trsl.2020.03.013

Table 1.

Frailty estimates in cancer survivors

Author Year published Population Study design N Age Frailty measure Prevalence or “Average” Frailty score Predictors of frailty Other health outcomes
Childhood, adolescent and young adult cancer
Hayek 2019 Childhood cancer survivors and siblings; 48% male; 86% white Retrospective cohort 10,899 survivors; 2.097 siblings Mean 37.6±9.6y survivors; 42.9±9.4y siblings Self-report, modified Fried criteria 6.4% survivors; 2.2% siblings Amputation; cranial, pelvic or abdominal radiation, platinum exposure, lung surgery  
Van lersel 2019 Childhood cancer survivors Cross-sectional 3,141 survivors Median 31.7y Performance-based; modified Fried Criteria 5.7% Growth hormone deficiency  
Smitherman 2018 Adolescent and young adult cancer survivors (≥1y post treatment) Cross-sectional 271 15–39y Self-report of fatigue, difficulty climbing stairs, activities of daily living, comorbid conditions, weight loss - frailty characterized as endorsing ≥3 10% Smoking, obesity, anxiety or depression, delayed care because of lack of insurance  
Eissa 2017 Survivor of leukemia or lymphoma treated with or without HCT during childhood Retrospective cohort 112 treated with HCT/1106 treated without HCT 28.4 ± 5.9y HCT; 29.3 ± 6.2y conventional therapy Performance-based; modified Fried Criteria 7.1% among those treated with HCT; 1.6% among those treated with conventional therapy HCT Severe, disabling, life threatening chronic conditions
Chemaitilly 2017 Childhood cancer survivors, female Cross-sectional 921 Median 31.7y Performance-based; modified Fried Criteria 4.9% among those without premature ovarian insufficiency, 16.0% among those with premature ovarian insufficiency Premature ovarian insufficiency  
Vatanen 2017 Survivors of childhood high-risk neuroblastoma Cross Sectional 19 survivors, 20 age and sex-matched controls Median 22 (16–30)y   47% survivors, 0% controls telomere length, higher levels of C-reactive protein  
Wilson 2016 Survivors of Acute Lymphoblastic Leukemia treated during childhood Cross Sectional 862 Median 31.3 (18.4–59.7)y Performance-based; modified Fried Criteria 18.6% were pre-frail or frail GHD, smoking  
Ness 2013 Adult survivors of childhood cancer Retrospective cohort - prospective follow-up 1,922 Mean age 33.6±8.1y Performance-based; modified Fried Criteria 7.90% Chronic conditions, cranial radiation, pelvic radiation, smoking Frailty was associated with new onset chronic conditions and with mortality
Hematopoietic stem cell transplant
Arora 2016 Survivors (≥2y) of HCT 18–64 y and siblings Retrospective cohort 998 survivors, 297 siblings 42.5±11.6y survivors. 43.8±10.9y siblings Self-report, modified Fried criteria 8.4% survivors, 0.7% siblings Graft versus host disease; severe, disabling or life-threatening chronic conditions Frailty was associated with mortality
Breast cancer
Mandelblatt 2018 Non-metastatic breast cancer patients and matched controls aged ≥60y Prospective cohort 344 patients; 347 controls 60–98y Searle’s deficits accumulation index (pre-frail defined as 0.2–0.35; frail as ≥0.35) 25.6% patients; 18.1% controls prefrail/frail Frailty was used as a predictor of cognitive outcomes Prefrailty/frailty associated with attention, processing speed, executive function at baseline
Mandelblatt 2016 Non-metastatic breast cancer patients, 41% treated with chemotherapy Prospective cohort 1,280 65–91y (mean 74.1) Searle’s deficits accumulation index (pre-frail defined as 0.2–0.35; frail as ≥0.35) 5.1% frail, 18.3% pre-frail Frailty status was used as a predictor of cognition Self-reported cognitive function from the EORTC QLQ-30
Bennett 2013 Breast cancer survivors not participating in exercise Cross-sectional 216 53–87 Fried Criteria 18% frailty among 70–79y old;
50% of cohort pre-frail
Obesity, sedentary behavior Data were compared to published data from the Cardiovascular Health Study and the Women’s Health and Aging Study
Prostate cancer
Winters-Stone 2017 Prostate cancer survivors Cross-sectional 280 Mean 72±8y Self-report of fatigue, difficulty climbing stairs, activities of daily living, comorbid conditions, weight loss or obesity) where frailty characterized as endorsing ≥3 of these 59% among those on androgen deprivation therapy; 62% among those who previously used ADT therapy and 25% among those who never used ADT ADT  
Bylow 2011 Men with prostate cancer Case-control 63 with biochemical recurrence of PC on ADT; 60 without recurrence Cases 72.1±7.0y Controls 70.5±6.3y Performance-based; modified Fried Criteria (replacing weight loss with obesity (BMI≥30 kg/m2) 8.7% with ADT frail; 2.9% without ADT Frail Comorbidities, ADT Frailty was associated with falls and lower performance on the Short Physical Performance Battery
Colorectal cancer
Ronning 2016 Persons with colorectal cancer referred for surgery Prospective cohort 68 mean 79y (range 70–94) Frailty classified as one of physical dependence in basic ADL measured by the Barthel index, >1 grade 4 comorbidity/>2 grade 3 comorbidities on the cumulative rating scale for geriatrics, a score of <17 on the mini nutritional assessment, score <24 on the mini-mental status examination, score of >13 on the geriatric depression scale, or daily use of ≥8 medications 35% Frailty was used as a predictor of QOL Quality of Life - EORTC-QLQ-C30 - Frailty was associated with QOL at all time points (baseline, 3 months, 18 months)
Ronning 2014 Patients undergoing elective surgery for colorectal cancer Prospective follow-up 38–84 depending on outcome Median 82 (72–95)y Frailty classified as one of: physical dependence in basic ADL measured by the Barthel index, >1 grade 4 comorbidity/>2 grade 3 comorbidities on the cumulative rating scale for geriatrics, a score of <17 on the mini nutritional assessment, score <24 on the mini-mental status examination, score of >13 on the geriatric depression scale, or daily use of ≥8 medications Overall prevalence not reported Frailty used as a predictor of decline in physical function Frailty was not associated with performance outcomes
Lung cancer
Franco 2018 Patients with stage I/II non-small-cell lung cancer treated with stereotactic body radiation therapy Retrospective review 139 Median 74y Modified frailty index (11-point tally of performance status ≥2, impaired sensorium, diabetes mellitus, chronic/acute lung disease, myocardial infarction in past ≤6 months, hospitalization for congestive heart failure in past ≤6 months, coronary or cardiac disease, hypertension on medications, history of transient ischemic attack, cerebrovascular accident or stroke with neurological deficits, and peripheral vascular disease. Frailty status was defined as non-frail (score 0–1) and frail (score ≥2) 72.7% Frailty was used to predict overall and cause specific survival Frailty associated with three-year overall survival and non-cancer death
Head and neck cancer
Johnson 2014 Patients undergoing tracheostomy, 100% male Retrospective chart review 99 (38 with head and neck cancer) Median 64 (35–89)y Risk Analysis Index - a modification to the Revised Minimum Data Set Mortality Rating Index (11 weighted items) Score (out of 100%) 44.9% for those with head and neck cancer; 30.2% for those without head and neck cancer Frailty used to predict mortality This instrument did not differentiate between head and neck cancer patients who survived <6 months compared to those who survived ≥6 months
Mixed diagnoses
Shahrokni 2019 Cancer patients ≥75y; 51.2% female Prospective cohort 1,137 cancer patients Median 80y Memorial-Sloan Kettering Frailty Index (tally of comorbid disease at admission) 41.2% had MSK-FI score ≥3 Score on the MSK-FI was evaluated as the predictor of post-surgical adverse outcomes Higher MSK-FI associated with increased length of stay, risk for intensive care unit admission, mortality
Moore 2018 REGARDS Cohort (population-based study of adults ≥45y, 45% male, 41% black) Prospective cohort 2773 cancer survivors; 25.289 without cancer history 69y survivors, 64y those without cancer history Self-report where frailty characterized as 2 of any of weakness, exhaustion, or low physical activity 23% survivors, 20% those without cancer history Frailty was evaluated as a mediator of the association between cancer history and hospital admission for community acquired sepsis Frailty was a weak mediator of the association between cancer history and community acquired sepsis
Pamoukdjian 2017 Outpatients with cancer. 50.5% male Prospective cohort 190 Mean 80.6±5.6y Gait speed <0.8 meter/second 50.5% Gait speed was used to predict mortality Gait speed was independently associated with mortality
Perez-Zepeda 2016 Mexican older adults enrolled in the Mexican Health and Aging Study Nested Case-Control Study 8022 (288 with cancer history) Median age 70.6y 55 item frailty index where incident frailty defined as >0.25 and worsening frailty defined as negative residual value from frailty index scores 11 years apart 29.9% incident frailty, 53.8% worsening frailty Shorter time <10y from diagnosis associated with both incident and worsening frailty  
Brown 2015 National Health and Nutrition Examination Survey III Population Based Sample of Older Adults with a Non-Skin Cancer History Mortality Linked Prospective Cohort Study 416 Median 72.2y Performance-based; modified Fried Criteria 37.3% Pre-frail, 9.1% frail Frailty used as predictor of all- cause mortality Prefrailty and frailty were associated with mortality

y=years, %=percent, MSK-FI=Memorial Sloan Kettering Frailty Index, EORTC QLQ-30= European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, HCT= hematopoietic stem cell transplant, QOL=Quality of Life, PC=Prostate cancer, ADT=Androgen deprivation therapy, ADL=Activities of daily living, GHD=Growth hormone deficiency