Frailty in cancer patients

Abstract

An older cancer patient who is frail has reduced tolerance to treatment such as chemotherapy and surgery and is at increased risk of toxicity and complications. The term frailty is defined as an increased vulnerability to stressors due to a multisystem reduction in reserve capacity. Frailty is linked to higher chronological age and comorbidities but is considered a distinct concept. By identifying frailty in a cancer patient, the treating physician gets a more precise estimation of individual vulnerability compared to looking at chronological age alone. Recognizing frailty has consequences for treatment decisions in the oncology setting because frailty summarizes health status. A patient who is frail has a limited life expectancy compared to a fit patient with the same chronological age. When interpreting clinical trials in older cancer patients, reporting of patient frailty in addition to age is necessary because it is relevant for evaluating generalizability to clinical practice. Unfortunately, frail patients are often excluded from clinical trials.