title: Performance of Four Frailty Classifications in Older Patients With Cancer: Prospective Elderly Cancer Patients Cohort Study.
abstract: Purpose Frailty classifications of older patients with cancer have been developed to assist physicians in selecting cancer treatments and geriatric interventions. They have not been compared, and their performance in predicting outcomes has not been assessed. Our objectives were to assess agreement among four classifications and to compare their predictive performance in a large cohort of in- and outpatients with various cancers. Patients and Methods We prospectively included 1,021 patients age 70 years or older who had solid or hematologic malignancies and underwent a geriatric assessment in one of two French teaching hospitals between 2007 and 2012. Among them, 763 were assessed using four classifications: Balducci, International Society of Geriatric Oncology (SIOG) 1, SIOG2, and a latent class typology. Agreement was assessed using the κ statistic. Outcomes were 1-year mortality and 6-month unscheduled admissions. Results All four classifications had good discrimination for 1-year mortality (C-index ≥ 0.70); discrimination was best with SIOG1. For 6-month unscheduled admissions, discrimination was good with all four classifications (C-index ≥ 0.70). For classification into three (fit, vulnerable, or frail) or two categories (fit v vulnerable or frail and fit or vulnerable v frail), agreement among the four classifications ranged from very poor (κ ≤ 0.20) to good (0.60 < κ ≤ 0.80). Agreement was best between SIOG1 and the latent class typology and between SIOG1 and Balducci. Conclusion These four frailty classifications have good prognostic performance among older in- and outpatients with various cancers. They may prove useful in decision making about cancer treatments and geriatric interventions and/or in stratifying older patients with cancer in clinical trials.
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Emilie
authors.initials: E
authors.lastname: Ferrat
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Philippe
authors.initials: P
authors.lastname: Caillet
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Marie
authors.initials: M
authors.lastname: Laurent
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tournigand
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Jean-Léon
authors.initials: JL
authors.lastname: Lagrange
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Droz
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Lodovico
authors.initials: L
authors.lastname: Balducci
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Etienne
authors.initials: E
authors.lastname: Audureau
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Florence
authors.initials: F
authors.lastname: Canouï-Poitrine
authors.affiliation: Emilie Ferrat, Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Université Paris-Est Créteil; Elena Paillaud, Philippe Caillet, Marie Laurent, Christophe Tournigand, Jean-Léon Lagrange, Etienne Audureau, Florence Canouï-Poitrine, and Sylvie Bastuji-Garin, Assistance Publique Hôpitaux de Paris, Henri-Mondor Teaching Hospital, Créteil; Jean-Pierre Droz, Claude-Bernard-Lyon-1 University and Centre Léon-Bérard, Lyon, France; and Lodovico Balducci, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies