Study Highlights Importance of Pretreatment Frailty Assessments for Older Adults With Advanced NSCLC

For older adults with advanced non-small cell lung cancer (aNSCLC) receiving chemotherapy, geriatric assessment, although recommended by national guidelines, is not widely utilized to assess for frailty. However, a recent study sheds light on the importance of implementing pretreatment frailty assessments and how they can help predict survival outcomes and toxicity, as well as identify older adults at a higher risk for poor treatment outcomes.

Howard J. Lee, Jr., MD, of the University of California, San Francisco, and colleagues conducted the study to explore the association of frailty in older adults with aNSCLC with overall survival (OS), functional decline, toxicity, and hospitalization. The study was published in The Oncologist.

It was important to analyze frailty in this patient population due to the increased use of immunotherapy and targeted therapies for aNSCLC. Furthermore, additional barriers to geriatric assessment, such as synthesizing assessment results into a clinically relevant summary score, pose challenges for providers.

The trial analyzed data from 155 patients with aNSCLC who were aged 65 years or older and were “starting systemic therapy with non-curative intent.” All patients underwent geriatric assessments over six months.

As part of the methodology, the investigators created a deficit-accumulation frailty index to differentiate between patients who were robust, pre-frail, or frail. Cox proportional hazards models, which were adjusted for race, insurance, and treatment, were used to evaluate any correlations between frailty and Karnofsky Performance Status (KPS) with OS. Logistic regression was used for hospitalizations, severe toxicity, and functional decline.

The results found that 45.8% of patients were classified as robust, 36.1% were pre-frail, and 18.2% were frail. The median OS was 17.9 months. Of the participants, 34.8% had a KPS ≥90, 32.9% had a KPS of 80, and 32.3% had a KPS ≤70.

According to the study findings, patients classified as pre-frail and frail experienced decreased OS outcomes compared to those who were classified as robust (hazard ratio [HR], 2.09, 95% CI, 1.31-3.34). In addition, patients classified as pre-frail and frail were more likely to be hospitalized, experience functional decline, and experience grade 3 or higher hematologic toxicity than those classified as robust.

Ultimately, KPS was found only to be associated with OS. However, the frailty index created by the researchers was associated with hospitalization, OS, functional decline, and hematologic adverse events among the study participants. These findings were significant, as the study showed that a deficit-accumulation frailty index can translate the results of geriatric assessments to identify patients at risk for poorer outcomes, who may otherwise have been missed by traditional performance status assessments.

In conclusion, the investigators stated that “integration of pretreatment frailty assessment into clinical workflows may help oncologists better identify older adults at risk for poor outcomes to optimize decision-making and supportive care.”

Source: The Oncologist