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The Prognostic Role of Frailty and Its Recognition With Simple FRAIL and Fried Frailty Questionnaires in Advanced
Pia Weinländer1,2,3, Sara Hadzibegovic1,2,4, Jan Porthun1,3,5
1Charité - University Medicine Berlin Corporate Member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.
Background:
Patients with advanced cancer frequently suffer from frailty associated with vulnerability and adverse outcomes. Our aim was to assess the prevalence of frailty and elucidate the utility of two commonly used frailty questionnaires in an advanced cancer population.
Methods:
The Fried Frailty Phenotype (FFP) and Simple FRAIL Questionnaire (SFQ) were assessed in hospitalized patients with mostly advanced cancer. Patients were classified by both questionnaires as frail (3-5 points), pre-frail (1-2 points) and robust (0 points) and followed up for all-cause mortality. Utility was evaluated with correlation and survival analysis.
Results:
From 11/2017 to 02/2020, 251 mostly advanced cancer patients (61 ± 13 years, 53% men, BMI 25.3 ± 4.8 kg/m2, 78% cancer stage ≥ 3) were prospectively enrolled. In cancer patients, according to the FFP and SFQ, 17%/13% were frail, 52%/41% prefrail and 31%/47% robust. The correlation between both scores was strong (rs = 0.65, p < 0.001). Both scores were predictors of mortality of cancer patients in univariable and multivariable Cox proportional hazards analyses (multivariable adjusted: per 1 point: FFP: HR 1.36, 95% CI, 1.15-1.61, p < 0.001; SFQ: HR 1.29, 95% CI, 1.09-1.52, p = 0.003-adjustment for age, cancer stage/type, anti-cancer therapy naïve, sex, BMI, CKD and anaemia). The time-dependent multivariable adjusted area under the receiver operating characteristic curve for 6-/24-month survival follow-up for the FFP was 0.78 (95% CI, 0.70-0.86)/0.92 (95% CI, 0.87-0.98) and for the SFQ was 0.79 (95% CI, 0.69-0.88)/0.90 (95% CI, 0.83-0.97).
Conclusion:
Frailty and pre-frailty as assessed by FFP and SFQ are commonly found in advanced stage cancer patients. Both questionnaires have a strong correlation and are associated with all-cause mortality in this population. Since the SFQ is easier and quicker to perform, it can be used remotely, and with untrained staff, it might facilitate earlier preventive measures and initiate further actions to mitigate its impact.
