Article Text
Abstract
Introduction There is limited literature on the impact of frailty on oncologic outcomes. We sought to evaluate survival outcomes in a gynecologic oncology population.
Methods Using province-wide administrative data, patients undergoing a laparotomy for a gynecologic malignancy between 2009-2021 were identified. Frailty was defined using the preoperative frailty index(pFI) and the John Hopkins Adjusted Clinical Groups frailty indicator(ACG). Hazard ratios (HR) were calculated using multivariable cox regression models. Kaplan-Meier curves were used to describe 5-year survival.
Results Of 21,359 patients, 1,405(6.6%) and 1,144(5.4%) were frail using the pFI and ACG, respectively. On multivariable regression analysis adjusting for age, primary cancer, stage, and Charlson comorbidity score, frailty was associated with lower 5-year survival (pFI: HR 1.3, 95% CI 1.2-1.42, p<0.0001, ACG: HR 1.56, 95% CI 1.43-1.70, p<0.0001). By cancer type, frailty was associated with adverse 5-year survival for endometrial cancer (HR 1.60, 95% CI 1.39-1.88, p<0.0001, ACG: 1.77, 95% 1.55-2.03, p<0.0001), and ovarian/primary peritoneal/tubal cancer (pFI: HR 1.16, 95% CI 1.03-1.30, p=0.01, ACG: 1.38, 95% CI 1.21-1.56, p<0.0001), and but not for cervical cancer (pFI: HR 0.78, 95% CI 0.37-1.66, p=0.52, ACG: 1.74, 95% CI 0.94=3/24, p=0.08). Frailty(pFI) was not associated with a different interval to initiation of adjuvant chemotherapy for ovarian cancer (pFI: mean 6 weeks(standard deviation(SD) 4.3) vs 6.5 weeks(SD 4.8), p=0.08, ACG: mean 6.6 weeks(SD 4.9), vs 6.5 weeks(SD 4.7), p=0.71).
Conclusion/Implications Frailty was significantly associated with adverse long-term oncologic survival, particularly in those with endometrial and ovarian cancer. Future research on the management of frailty is warranted.