Screening for Frailty in Older Patients With Early-Stage Solid Tumors: A Prospective Longitudinal Evaluation of Three Different Geriatric Tools.
BACKGROUND
Frailty increases the risk of adverse health outcomes and/or dying when exposed to a stressor, and routine frailty assessment is recommended to guide treatment decision. The Balducci frailty criteria (BFC) and Fried frailty criteria (FFC) are commonly used, but these are time consuming. Vulnerable Elders Survey-13 (VES-13) score of ≥7, a simple and resource conserving function-based scoring system, may be used instead. This prospective study evaluates the performance of VES-13 in parallel with BFC and FFC, to identify frailty in elderly patients with early-stage cancer.


METHODS
Patients aged ≥70 years with early-stage solid tumors were classified as frail/nonfrail based on BFC (≥1 criteria), FFC (≥3 criteria), and VES-13 (score ≥ 7). All patients were assessed for functional decline and death.


RESULTS
We evaluated 185 patients. FFC had a 17% frailty rate, whereas BFC and VES-13 both had 25%, with poor concordance seen between the three geriatric tools. FFC (hazard ratio = 1.99, p = .003) and VES-13 (hazard ratio = 2.81, p < .001) strongly discriminated for functional decline, whereas BFC (hazard ratio = 3.29, p < .001) had the highest discriminatory rate for deaths. BFC and VES-13 remained prognostic for overall survival in multivariate analysis correcting for age, tumor type, stage, and systemic treatment.


CONCLUSIONS
A VES-13 score of ≥7 is a valuable discriminating tool for predicting functional decline or death and can be used as a frailty-screening tool among older cancer patients in centers with limited resources to conduct a comprehensive geriatric assessment.
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Laura
L
Biganzoli
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Anna Rachelle
AR
Mislang
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Samantha
S
Di Donato
Geriatric Medicine Unit, Nuovo Ospedale-Santo Stefano, Prato, Italy.
Dimitri
D
Becheri
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Chiara
C
Biagioni
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.|Universita degli Studi di Siena, Toscana, Italy.
Stefania
S
Vitale
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Giuseppina
G
Sanna
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Elena
E
Zafarana
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Stefano
S
Gabellini
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Francesca
F
Del Monte
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.|Universita degli Studi di Siena, Toscana, Italy.
Elena
E
Mori
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Daniele
D
Pozzessere
Medical Oncology 1 Unit, Instituto Oncologico Veneto IOV-IRCCS, Padova, Italy.
Antonella
A
Brunello
Medical Oncology Unit, Ospedale S. Paolo-Polo Universitario, Milano, Italy.
Andrea
A
Luciani
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Letizia
L
Laera
Clinical Trials Coordinating Center, Instituto Toscano Tumori, Firenze, Italy.
Luca
L
Boni
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Angelo
A
Di Leo
Geriatric Medicine Unit, Nuovo Ospedale-Santo Stefano, Prato, Italy.
Giuseppe
G
Mottino
D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000379:methods*; D018450:Disease Progression; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007558:Italy; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis
Balducci frailty criteria; Cancers; Frailty; Fried frailty criteria; Vulnerable Elders Survey-13