The Prognostic Importance of Frailty in Cancer Survivors

Abstract

Objectives To quantify the prognostic importance of prefrailty and frailty in a population-based sample of cancer survivors. Design The Third National Health and Nutrition Examination Survey mortality-linked prospective cohort study. Setting Eighty-nine survey locations across the United States. Participants Population-based sample of older adults (average age 72.2) with a self-reported diagnosis of non-skin-related cancer (N = 416). Measurements The primary outcome was all-cause mortality. Frailty components included low weight for height, slow walking, weakness, exhaustion, and low physical activity. Participants with none of the five criteria were classified as nonfrail, those with one or two as prefrail, and those with three or more as frail. Results The prevalence of prefrailty was 37.3% and of frailty was 9.1%. During a median follow-up of 11.2 years, 319 (76.7%) participants died. Median survival was 13.9 years for participants classified as nonfrail, 9.5 years for those classified as prefrail, and 2.5 years for those classified as frail. Cancer survivors classified as prefrail (hazard ratio (HR) = 1.84, 95% confidence interval (CI) = 1.28-2.65, P =.001) or frail (HR = 2.79, 95% CI = 1.34-5.81, P =.006) had a higher risk of premature mortality than those classified as nonfrail. Conclusion Prefrailty and frailty are prevalent clinical syndromes that may confer greater risk of premature mortality in older adult cancer survivors. Identifying frail cancer survivors and targeting interventions for them may be a strategy to improve survival after cancer.