Table 1.
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