Frailty and Oncology: An Increasingly Common Combination

Frailty is defined by a reduction in physiological reserve and an increased vulnerability to stressors. In oncology, frailty is highly prevalent and has been consistently associated with a worse prognosis. The aim of this manuscript is to understand the interaction between frailty and cancer to optimise therapeutic decision-making and improve patient-centred outcomes.

A narrative literature review was conducted using the PubMed database, with articles published up to July 2025 included. The search terms used included "frailty", "oncology", "cancer", "malignancy", "diagnosis", "optimisation", "treatment" and "prognosis". In accordance with the protocol, the following documents were prioritised: clinical guidelines, systematic and narrative reviews, observational studies, and randomised clinical trials.

Frailty has been shown to independently predict postoperative morbidity, chemotherapy toxicity, functional decline, and mortality. This can result in both undertreatment and overtreatment. Consequently, frailty assessment has emerged as a cornerstone of personalised oncology, enabling treatment individualisation beyond tumor characteristics alone. While a Comprehensive Geriatric Assessment remains the gold standard for frailty evaluation, screening tools should be used to facilitate risk stratification in routine practice. Incorporating frailty into decision-making processes has been shown to reduce inappropriate undertreatment and overtreatment, improve treatment tolerance, and facilitate shared decision-making. Multimodal, patient-centred interventions, such as exercise, nutritional support, medication optimisation, psychosocial care, and early palliative integration, mitigate frailty, enhance quality of life, and support adherence to individualised therapeutic plans. Oncogeriatric models of care further operationalise personalised medicine by coordinating these interventions within multidisciplinary teams.

It is crucial to acknowledge frailty as a pivotal clinical variable, rather than considering it a contraindication to cancer treatment. Health systems should promote structured frailty evaluation, professional training, and institutional pathways to ensure equitable, patient-centred management of frail individuals with cancer. Integrating frailty into oncology clinical practice operationalises personalised medicine by shifting the focus from treating the disease to treating the whole patient.