Article Text

Download PDFPDF
Frailty as a predictor of delayed initiation of adjuvant chemotherapy in patients with ovarian cancer
  1. Sebastian Z Ramos1,
  2. Amita Kulkarni1,
  3. Matthew Oliver2,
  4. Valery A Danilack3 and
  5. Cara Mathews2
  1. 1Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
  2. 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
  3. 3Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
  1. Correspondence to Dr Amita Kulkarni, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA; amita.a.kulkarni.10{at}gmail.com

Abstract

Objective This study aimed to identify whether frailty is associated with the time between surgery and the initiation of chemotherapy for patients with ovarian cancer.

Methods This retrospective cohort study included patients 18 years or older with stage II to IV ovarian cancer who underwent primary debulking surgery at a tertiary medical center between July 2006 and July 2015. Basic demographics and clinical information were obtained from a departmental database and the electronic medical record. The Modified Frailty Index (mFI) was calculated based on 10 comorbidities and functional status yielding 11 items total. Patients were categorized by a total score: 0–1=no frailty, 2=moderate frailty and 3+=high frailty.

Results Among 451 patients, 359 had mFI scores of 0–1, 60 had a score of 2, and 32 had scores of 3+. Mean time from surgery to initiation of chemotherapy was 37 days. Mean number of days between surgery and initiation of chemotherapy increased with increasing frailty score: 36 days for the not frail group, 39 days for the moderate frailty group, and 54 days for the high frailty group (p<0.001). Time to initiation of chemotherapy of 42 days or more occurred in 23% of the no frailty group, 28% in the moderate frailty group, and 63% in the high frailty group (p<0.001). Overall survival decreased with increasing frailty scores.

Conclusion High mFI scores lead to a greater delay between surgery and chemotherapy initiation. Being able to predict delays in initiation of chemotherapy may allow oncologists to consider neoadjuvant chemotherapy, pre-habilitation before surgery, and improved preoperative counseling in high-risk patients.

  • ovarian cancer

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text

Footnotes

  • Contributors SZR: conceptualization, investigation, methodology, data curation, visualization, writing – original draft. AK: data curation, investigation, writing – original draft. MO: visualization, writing – review and editing. VAD: methodology, statistical analysis, writing – review and editing. CM: Guarantor, conceptualization, methodology, visualization, writing – review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.