Frailty Classifications Associated With Prognosis Among Older Patients

Researchers examined 4 frailty classifications to compare their predictive performance.
Researchers examined 4 frailty classifications to compare their predictive performance.

Four frailty classifications, including Balducci, International Society of Geriatric Oncology (SIOG) 1, SIOG2, and a latent class typology, have good prognostic performance among both older inpatients and outpatients with various solid and hematologic malignancies, according to a study published in the Journal of Clinical Oncology.1

Researchers have developed frailty classifications of older patients with cancer to aid clinicians in making treatment decision and selecting geriatric interventions; however, no study has compared frailty classifications nor evaluated their performance in predicting outcomes.

To assess agreement among 4 classifications and compare their predictive performance in a large cohort of inpatient and outpatients with various malignancies, investigators prospectively included 1021 patients aged 70 years or older with solid or hematologic cancers who underwent a geriatric assessment in 1 of 2 French teaching hospitals between 2007 and 2012.

Researchers measured frailty using 4 classifications: Balducci, SIOG1, SIOG2, and a latent class typology. One-year mortality and 6-month unscheduled admissions were used as outcomes.

Results showed that all 4 classifications had good discrimination of 1-year mortality, with discrimination being best with SIOG1 following by the latent class typology. Similarly, discrimination was good with all 4 classifications for 6-month unscheduled admissions.

However, researchers found that when patients were classified into 3 (fit, vulnerable, or frail) or 2 categories (fit vs vulnerable or frail and fit or vulnerable vs frail), agreement among the 4 classifications ranged from very poor to good, with agreement being best between SIOG1 and the latent class typology and between SIOG1 and Balducci.

The study also demonstrated that performance of the classifications varied across tumor sites. Discrimination was very good for predicting mortality in patients with prostate and breast cancers and lower for colorectal cancers.

Despite poor to moderate agreement among the 4 frailty classifications of older patients with cancer, all 4 classifications consistently performed well with respect to predicting 1-year overall mortality and 6-month unscheduled admissions in this large cohort of older, treatment-naïve patients.

Reference

1. Ferrat E, Paillaud E, Caillet P, et al. Performance of four frailty classifications in older patients with cancer: prospective elderly cancer patients cohort study. J Clin Oncol. 2017 Jan 17. doi: 10.1200/JCO.2016.69.3143. [Epub ahead of print]

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