Validation of a frailty index in older cancer patients with solid tumours
Validation of a frailty index in older cancer patients with solid tumours
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DOI：
10.1186/s12885-018-4807-6
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发表时间：
2018-09-14
期刊：
影响因子：
3.8
通讯作者：
Hubbard, R. E.
中科院分区：
文献类型：
--
作者：
McCarthy, A. L.;Peel, N. M.;Hubbard, R. E.
背景：虚弱是老年人生理储备的一个指标。在非癌症环境中，虚弱指数是不良健康结果的可靠预测指标。本研究的目的是1)从实体瘤化疗环境中获得的综合老年评估（CGA）数据中得出并验证虚弱指数（FI）， 2)探讨FI-CGA是否可以预测老年实体瘤癌症患者的化疗决策和生存。方法：前瞻性队列研究175例65岁及以上的实体肿瘤患者的连续系列样本。使用累积缺陷模型计算衰弱指数，在化疗决策之前使用综合老年评估工具进行编码。身体和认知功能、营养、情绪、日常生活的基本和工具活动以及合并症等领域被纳入模型的缺陷。结果：FI-CGA呈右偏态分布，中位数（四分位数间距）为0.27（021-039）。赤字积累的99%限制低于理论最大值1.0，为0.75。FI-CGA与脆弱老年人调查-13评估的脆弱性显著相关（p < 0.001），与医学肿瘤学家对治疗适应性或脆弱性的评估显著相关。FI-CGA确定的基线脆弱性也与治疗决策相关（治疗终止、治疗完成、无计划治疗）（p < 0.001），无计划治疗组明显弱于其他两组。结论：FI-CGA是癌症临床决策的潜在有用辅助手段，可以预测老年实体瘤患者的化疗结果。
Background: Frailty is an indicator of physiological reserve in older people. In non-cancer settings, frailty indices are reliable predictors of adverse health outcomes. The aims of this study were to 1) derive and validate a frailty index (FI) from comprehensive geriatric assessment (CGA) data obtained in the solid tumour chemotherapy setting, and 2) to explore whether the FI-CGA could predict chemotherapy decisions and survival in older cancer patients with solid tumours.Methods: Prospective cohort study of a consecutive series sample of 175 cancer patients aged 65 and older with solid tumours. A frailty index was calculated using an accumulated deficits model, coding items from the comprehensive geriatric assessment tool administered prior to chemotherapy decision-making. The domains of physical and cognitive functioning, nutrition, mood, basic and instrumental activities of daily living, and comorbidities were incorporated as deficits into the model.Results: The FI-CGA had a right-skewed distribution, with median (interquartile range) of 0.27 (021-039). The 99% limit to deficit accumulation was below the theoretical maximum of 1.0, at 0.75. The FI-CGA was significantly related (p < 0.001) to vulnerability as assessed by the Vulnerable Elders Survey-13 and to medical oncologists' assessments of fitness or vulnerability to treatment Baseline frailty as determined by the FI-CGA was also associated with treatment decisions (Treatment Terminated, Treatment Completed, No Planned Treatment) (p < 0.001), with the No Planned Treatment group significantly frailer than the other two groups.Conclusion: The FI-CGA is a potentially useful adjunct to cancer clinical decision-making that could predict chemotherapy outcomes in older patients with solid tumours.