Assessment and impact of frailty and comorbidity in older cancer patients

Abstract

Half of cancer patients are 70 years or older when they are diagnosed. These patients represent a heterogeneous group with respect to general health, comorbidity, physical and cognitive functioning, factors that may all affect the course and outcomes of cancer treatment. By systematically assessing these areas in a geriatric assessment a patient’s level of frailty can be determined. The aims of this thesis were to investigate clinicians’ ability to identify comorbidity and frailty in comparison to systematic assessments, and the impact of frailty on survival and quality of life during cancer treatment and follow-up. Data from two study cohorts were used; comorbidity assessments from a national chemotherapy trial of advanced non-small-cell lung cancer patients, and frailty and follow-up assessments from a prospective, observational study of older cancer patients referred for systemic cancer treatment. Frailty was assessed by a modified geriatric assessment. We found that clinicians registered considerably less comorbidity and identified frailty in fewer patients compared to when using systematic comorbidity and frailty assessments, and there was little agreement between the registrations. Only the systematic frailty assessment was independently prognostic for survival. Our results suggest that the assessment method used affects the amount of measured comorbidity, and that systematic assessment is superior to clinical judgement in identifying frailty. Frail patients had significantly poorer survival, more symptoms and poorer functioning both at inclusion and during follow-up. They also had a significant decline in physical function the first year of follow-up. This study contributes to increased knowledge of a patient group often excluded from clinical trials and unveils a group of frail patients in need of early symptomatic treatment and early palliative care in parallel with their oncological treatment.