Frailty and Days at Home After Ovarian Cancer Surgery- A Patient-Centered Outcome for Older Adults

Ovarian cancer debulking is associated with improved survival but carries significant morbidity, and data on meaningful outcomes among older adults remain limited. This study evaluated the association between frailty and days at home (DAH) at 1 year after surgery and identified modifiable factors.

This is a population-based study of Medicare fee-for-service beneficiaries (2014-2019) undergoing surgery for ovarian cancer. The primary exposure was a claims-based frailty index (CFI). The primary outcome was DAH at 1 year after surgery, calculated by subtracting hospital (inpatient, emergency department, and observation), nursing home (long-term hospital, skilled nursing, and rehabilitation facility), and death (days not alive) days from 365. Outcomes were stratified by frailty and age, and a multivariate linear regression model identified significant predictors of DAH.

Among 7,348 patients (mean [SD] age, 74.3 [6.0] years), 44.0% were robust, 49.8% prefrail, and 6.2% frail. Mean [SD] DAH for all patients was 323 [89]; frail patients had significantly fewer DAH (269 [126]), as did prefrail patients (315 [96]), compared with robust patients (330 [68]) (P<.001). Robust older (age ≥80 years) patients had higher DAH than their frail younger (aged <70 years) counterparts (330 [79] vs 275 [117]). After 90 days, long-term mortality contributed to more loss in DAH through death days (26 [73]) than through hospital (3 [8]) or nursing home (2 [11]) days. Before 90 days, DAH were lost to hospital (6 [8)] and nursing home (3 [9]) rather than death (2 [10]) days. Frailty was the strongest predictor of fewer DAH (-52; 95% CI, -61 to -43) followed by high-risk surgical procedures (-30; 95% CI, -35 to -25). Minimally invasive surgery (MIS) was associated with higher DAH (+28 days; 95% CI, 24 to 33; P<.001).

Frailty is the strongest predictor of DAH at 1 year after ovarian cancer surgery. Including frailty in surgical risk stratification, minimizing high-risk procedures, and utilizing MIS may improve patient-centered care for older adults with ovarian cancer.