The Frailty Index in older women with gynecological cancer
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ORIGINAL ARTICLE
The Frailty Index in older women with gynecological cancer Laura Orlandini1 · Tiziano Nestola1 · Giuseppe Ferdinando Colloca2 · Alessandro Ferrini3 · Matteo Cesari4,5 Received: 1 October 2019 / Accepted: 3 January 2020 © Springer Nature Switzerland AG 2020
Abstract Introduction Frailty is a key condition to be screened among elderly oncological patients. Aim of our work is to measure the functional and prognostic value for 1-year mortality of the Frailty Index (FI) in a cohort of older women with gynecological cancer. Methods The prognostic value of FI was tested in 200 older women with gynaecological cancer (mean age = 73.5 years). FI was retrospectively calculated following the Rockwood model. Spearman’s rho test was used for correlations with other oncological scales: Eastern Cooperative Oncology Group Performance Status (ECOG); Karnofsky Performance Status (KPS); Vulnerable Elders Scale-13 (VES-13). Cox proportional hazard models and ROC curve were performed to estimate prognostic role of 1-year mortality. Sensitivity and specificity were also calculated. Results FI is normally distributed and descriptive statistics define our population as frail (mean = 0.25±0.11, range 0.080.51). 0.7 is confirmed as an upper limit compatible with life. FI does not significantly correlates with age, ECOG and KPS while it positively correlates with VES-13 (r = 0.7, p < 0.01). FI is the strongest predictor for 1-year mortality confirmed after all adjustments for confounders (OR 3.40; 95% CI 1.55–7.45, p < 0.01) and by ROC curve analyses (0.66, 95% CI 0.51–0.81, p = 0.01). Conclusions Frailty Index is a useful tool to detect vulnerability in onco-geriatrics and it predicts 1-year mortality. Further studies are needed to confirm and extend these findings. Keywords Oncogeriatrics · Frailty · Geriatric assessment
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-020-01473-8) contains supplementary material, which is available to authorized users. * Tiziano Nestola [email protected] 1
Fellowship in Geriatrics and Gerontology, University of Milan, via Pace 9, 20122 Milan, Italy
2
Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
3
Area di Geriatria, Policlinico Universitario Campus Biomedico, Rome, Italy
4
Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
5
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
The number of older cancer patients is rapidly growing as a consequence of global ageing and the easier access to (effective) therapies. However, older patients with cancer are frequently characterized by high complexity and frailty (i.e., a condition determined by reduced physiological reserves exposing the individual to the risk of homeostatic disruption). As a consequence, older persons are often excluded from aggressiv
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