Description of different domains used to assess frailty
Functional status	Function status, assessed by patient's ability to complete activities of daily living has been shown to be predictive of treatment related toxicity and survival in cancer patients [18,23,42]. The Instrumental Activities of Daily Living (IADL) is a subscale of the Multidimensional Functional Assessment Questionnaire (MFAQ): Older American Resources and Services (OARS). The OARS MFAQ was developed and then tested in more than 6000 older community residents. It consists of 7 questions rated on a 3-point Likert scale measuring the degree to which an activity can be performed independently [23]. The scores for this domain range from 0 to 14, with a lower score denoting more dependence. In this study, any dependency expressed by the score of less than 13 was considered significant deficit [23,42]. The Activities of Daily Living (ADL) is a subscale of the Medical Outcomes Study (MOS) Physical Health. It measures a broad range of physical functioning ranging from activities for self-care to more vigorous activities, such as running or lifting heavy objects. Items are rated on a 3-point Likert scale measuring independence in performing the activity [23]. Scores for this to mean range from 0 to 100. A lower score reflects more limitation in daily routine activities. In the current study, any dependency expressed by the score of less than 90 was considered significant deficit [42], (43). Karnofsky Performance Rating scale (KPS) The KPS is a measure of patient independence in carrying out routine daily activities and self-care. It was developed in 1948, and since then has been widely used in the oncology practice. It is a global indicator of functional status where patients are given a score on a numerical scale of 0–100 [18]. Both, patient-reported, and physician-reported KPS scale are part of the CARG tool. In the current study, a score of 70 or less was considered significant deficit [18]. Timed Up and Go The Timed Up and Go is a performance test of physical mobility which measures gait speed. It measures time in seconds an individual takes to stand up from a standard armchair, walk a distance of 3 m (10 ft), turn, walk back to the chair, and sit down again. TUG scores have been found to be predictive of functional decline and increasing disability in older cancer patients and increased mortality [24]. For the present study, a score of more than 10 was considered abnormal [18]. Number of falls in last 6 months History of falls not only estimates an older patients' disability, it also increases the risk of treatment associated toxicity. For example, there is an increase in the risk of fracture with fall in the presence of bony metastasis or increased bleeding because of chemotherapy induced haematological disorders [24]. Any history of fall in the last 6 months was considered significant [18].
Physical Health	The OARS (Older Americans Resources and Services) Physical Health Section is a self-reporting comorbidity scale containing a list of comorbid conditions and an assessment of their impact on daily activities, rated on a 3-point scale of “not at all” to “a great deal.” The OARS score has been validated in the studies on cancer patients [23]. The OARS assessed 13 common comorbid conditions. Presence of more than 2 comorbidities was considered significant. The number of current medications including over the counter medications was also recorded and poly pharmacy was defined as 3 or more medications [18]. Body mass index In this study a BMI of 30 or more was considered abnormal [18]. Percent unintentional weight loss in the last 6 months Studies on chemotherapy in older patients have shown increased mortality, lower chemotherapy response rates, and decreased performance status in patients with history of weight loss during the 6 months before chemotherapy [28]. Any un-intentional weight loss was considered significant.
Cognition	For assessment of cognition, the Blessed Orientation-Memory-Concentration (BOMC test) is used in the CARG tool. It consists of six questions. The scores were multiplied to yield a weighted score. A higher score more than 11 signifying cognitive impairment [25]
Psychologic	For depression and anxiety assessment, the Mental Health Inventory (MHI)-17 was used. It is a 14-item self-administered questionnaire which provides a score for patient on a scale of 0–100%. A lower score indicates presence of depression and anxiety. For the purpose of this study a score of less than 50 was considered abnormal [26]
Social Functioning	Social Activity Limitations subscale from the Medical Outcomes Study Social Activity Limitations Measure (MOS) was used to assess the impact of physical and emotional status on social functioning. It has four items which are rated on a 5-point Likert scale. The mean of the total score is transformed to a scale of 0–100, with a lower number indicating lack of support available. In this study a score of less than 50 was considered abnormal, [27]. Medical Outcomes Study Social Activity Limitations Measure (MOS) Social Support (MOSS-SS) was used to access to material aid or behavioural assistance and Emotional/Information (the expression of positive affect and empathetic understanding; the offering of advice, information, guidance, or feedback). The scale has two parts with 12 items which were rated on a 5-point Likert scale from “none of the time” to “all of the time” except one item. This domain is also expressed on a scale of zero to 100 with the higher score indicating better social support (Description and Scoring Instructions: MOS Social Support Survey, n.d.). In this study a score of less than 50 was considered abnormal [18].