title: Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy.
abstract: BACKGROUND
  Frailty has been suggested as a construct for oncologists to consider in treating older cancer patients. Therefore, the authors assessed the potential of creating a deficit-accumulation frailty index (DAFI) from a largely self-administered comprehensive geriatric assessment (CGA).
  
  
  METHODS
  Five hundred patients aged ≥65 years underwent a CGA before receiving chemotherapy. A DAFI was constructed, resulting in a 51-item scale, and cutoff values were examined for patients in the robust/nonfrail (cutoff value, 0.0 < 0.2), prefrail (cutoff value, 0.2 < 0.35), and frail (cutoff value, ≥ 0.35) groups.
  
  
  RESULTS
  Two hundred and fifty patients (50%) were nonfrail, 197 (39%) were prefrail, and 52 (11%) were frail. Older patients (aged ≥ 80 years) and those who had lower education, were living alone, and had higher stage disease were associated with prefrail/frail status. Prefrail/frail patients were more likely to have grade ≥3 toxicity but not to have a dose delay or reduction, and they were more likely to discontinue drug and be hospitalized. The association with grade ≥3 toxicity was attenuated by controlling for a toxicity risk calculator, but the other outcomes were not.
  
  
  CONCLUSIONS
  A deficit-accumulation frailty index can be constructed from a CGA in older patients with cancer and can indicate the frailty status of the population. The frailty status so determined is associated both with outcomes likely because of chemotherapy toxicity and with those likely because of age-related physiologic and functional deficits and thus can be useful in the overall assessment of the patient. Cancer 2016;122:3865-3872. © 2016 American Cancer Society.
authors.affiliation: Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.
authors.forename: Harvey Jay
authors.initials: HJ
authors.lastname: Cohen
authors.affiliation: QIMR Berghofer Medical Research Institute, Royal Brisbane and Women's Hospital, Brisbane City, Queensland, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.affiliation: City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California.
authors.forename: Can-Lan
authors.initials: CL
authors.lastname: Sun
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: William
authors.initials: W
authors.lastname: Tew
authors.affiliation: Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.affiliation: University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.affiliation: Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina.
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Klepin
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Lichtman
authors.affiliation: Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York.|Veterans Administration Medical Center, Syracuse, New York.
authors.forename: Ajeet
authors.initials: A
authors.lastname: Gajra
authors.affiliation: City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California.
authors.forename: Julie
authors.initials: J
authors.lastname: Filo
authors.affiliation: City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California.
authors.forename: Vani
authors.initials: V
authors.lastname: Katheria
authors.affiliation: City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, California.
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology*; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents
keywords: cancer; comprehensive geriatric assessment; deficit-accumulation index; frailty; geriatric