Open Access
Open access
Oxford University Press
Oncologist

Associations of frailty with survival, hospitalization, functional decline, and toxicity among older adults with advanced non-small cell lung cancer

Howard J Lee 1
, 
John Boscardin 2
, 
Louise C. Walter 2
, 
Alexander K. Smith 2
, 
Harvey J. Cohen 3
, 
Smith Giri 4
, 
Grant R. Williams 4
, 
Carolyn J. Presley 5
, 
Surbhi Singhal 6
, 
Li-Wen Huang 1, 7
, 
Ana I. Velazquez 1, 8
, 
Matthew A. Gubens 1, 8
, 
Collin M. Blakely 1, 8
, 
Claire K Mulvey 1, 8
, 
Michael L Cheng 1, 8
, 
Lori C. Sakoda 9, 10
, 
Lawrence H Kushi 9
, 
Charles Quesenberry 9
, 
Raymond Liu 9, 11
, 
Sara Fleszar-Pavlovic 12
, 
Caroline Eskandar 2
, 
Edward Cutler 13
, 
Anne Marie Mercurio 13
, 
Melisa L Wong 2, 9, 11
1
 
2
 
3
 
4
 
5
 
6
 
7
 
Division of Hematology-Oncology, San Francisco Veterans Affairs Health Care System , San Francisco, CA 94121 , | 
8
 
9
 
Division of Research, Kaiser Permanente Northern California, The Permanente Medical Group , Pleasanton, CA 94588 ,
10
 
Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine , Pasadena, CA 91101 , | 
11
 
Division of Hematology-Oncology, Kaiser Permanente San Francisco Medical Center, The Permanente Medical Group , San Francisco, CA 94115 , | 
12
 
13
 
Lens Study Patient and Caregiver Advisory Board , Pleasanton, CA 94588 ,
Publication type: Journal Article
Publication date: 2024-12-09
Oxford University Press
scimago Q1
wos Q2
SJR: 2.329
CiteScore: 9.2
Impact factor: 4.2
ISSN: 10837159, 1549490X
Abstract
Introduction

Among older adults with cancer receiving chemotherapy, frailty indices predict OS and toxicity. Given the increased use of immunotherapy and targeted therapy for advanced non-small cell lung cancer (aNSCLC), we evaluated frailty and Karnofsky Performance Status (KPS) among older adults with aNSCLC receiving chemotherapy, immunotherapy, and/or targeted therapy.

Methods

Patients aged ≥ 65 with aNSCLC starting systemic therapy with non-curative intent underwent geriatric assessments over 6 months. We developed a deficit-accumulation frailty index to categorize patients as robust, pre-frail, or frail. To evaluate associations between frailty and KPS with OS, we used Cox proportional hazards models adjusted for race, insurance, and treatment. We used logistic regression to evaluate hospitalizations, functional decline, and severe toxicity.

Results

Among 155 patients (median age 73), 45.8% were robust, 36.1% pre-frail, and 18.2% frail; 34.8% had a KPS ≥ 90, 32.9% had a KPS of 80, and 32.3% had a KPS ≤ 70. The median OS was 17.9 months. Pre-frail/frail patients had worse OS compared to robust patients (adjusted hazard ratio [HR] 2.09, 95% CI, 1.31-3.34) and were more likely to be hospitalized (adjusted odds ratio [OR] 2.21, 95% CI, 1.09-4.48), functionally decline (adjusted OR 2.29, 95% CI, 1.09-4.78), and experience grade ≥ 3 hematologic toxicity (adjusted OR 5.18, 95% CI, 1.02-26.03). KPS was only associated with OS.

Conclusions

Our frailty index was associated with OS, hospitalization, functional decline, and hematologic AEs among older adults with aNSCLC receiving systemic therapies, while KPS was only associated with OS. Pretreatment frailty assessment may help identify older adults at risk for poor outcomes to optimize decision-making and supportive care.

Found 
Found 

Top-30

Journals

1
Clinics in Geriatric Medicine
Clinics in Geriatric Medicine, 1, 33.33%
Clinics in Geriatric Medicine
1 publication, 33.33%
Drugs and Aging
Drugs and Aging, 1, 33.33%
Drugs and Aging
1 publication, 33.33%
Clinical Surgical Oncology
Clinical Surgical Oncology, 1, 33.33%
Clinical Surgical Oncology
1 publication, 33.33%
1

Publishers

1
2
Elsevier
Elsevier, 2, 66.67%
Elsevier
2 publications, 66.67%
Springer Nature
Springer Nature, 1, 33.33%
Springer Nature
1 publication, 33.33%
1
2
  • We do not take into account publications without a DOI.
  • Statistics recalculated weekly.

Are you a researcher?

Create a profile to get free access to personal recommendations for colleagues and new articles.
Metrics
3
Share
Cite this
GOST |
Cite this
GOST Copy
Lee H. J. et al. Associations of frailty with survival, hospitalization, functional decline, and toxicity among older adults with advanced non-small cell lung cancer // Oncologist. 2024.
GOST all authors (up to 50) Copy
Lee H. J., Boscardin J., Walter L. C., Smith A. K., Cohen H. J., Giri S., Williams G. R., Presley C. J., Singhal S., Huang L., Velazquez A. I., Gubens M. A., Blakely C. M., Mulvey C. K., Cheng M. L., Sakoda L. C., Kushi L. H., Quesenberry C., Liu R., Fleszar-Pavlovic S., Eskandar C., Cutler E., Mercurio A. M., Wong M. L. Associations of frailty with survival, hospitalization, functional decline, and toxicity among older adults with advanced non-small cell lung cancer // Oncologist. 2024.
RIS |
Cite this
RIS Copy
TY - JOUR
DO - 10.1093/oncolo/oyae349
UR - https://academic.oup.com/oncolo/advance-article/doi/10.1093/oncolo/oyae349/7919584
TI - Associations of frailty with survival, hospitalization, functional decline, and toxicity among older adults with advanced non-small cell lung cancer
T2 - Oncologist
AU - Lee, Howard J
AU - Boscardin, John
AU - Walter, Louise C.
AU - Smith, Alexander K.
AU - Cohen, Harvey J.
AU - Giri, Smith
AU - Williams, Grant R.
AU - Presley, Carolyn J.
AU - Singhal, Surbhi
AU - Huang, Li-Wen
AU - Velazquez, Ana I.
AU - Gubens, Matthew A.
AU - Blakely, Collin M.
AU - Mulvey, Claire K
AU - Cheng, Michael L
AU - Sakoda, Lori C.
AU - Kushi, Lawrence H
AU - Quesenberry, Charles
AU - Liu, Raymond
AU - Fleszar-Pavlovic, Sara
AU - Eskandar, Caroline
AU - Cutler, Edward
AU - Mercurio, Anne Marie
AU - Wong, Melisa L
PY - 2024
DA - 2024/12/09
PB - Oxford University Press
PMID - 39657913
SN - 1083-7159
SN - 1549-490X
ER -
BibTex
Cite this
BibTex (up to 50 authors) Copy
@article{2024_Lee,
author = {Howard J Lee and John Boscardin and Louise C. Walter and Alexander K. Smith and Harvey J. Cohen and Smith Giri and Grant R. Williams and Carolyn J. Presley and Surbhi Singhal and Li-Wen Huang and Ana I. Velazquez and Matthew A. Gubens and Collin M. Blakely and Claire K Mulvey and Michael L Cheng and Lori C. Sakoda and Lawrence H Kushi and Charles Quesenberry and Raymond Liu and Sara Fleszar-Pavlovic and Caroline Eskandar and Edward Cutler and Anne Marie Mercurio and Melisa L Wong},
title = {Associations of frailty with survival, hospitalization, functional decline, and toxicity among older adults with advanced non-small cell lung cancer},
journal = {Oncologist},
year = {2024},
publisher = {Oxford University Press},
month = {dec},
url = {https://academic.oup.com/oncolo/advance-article/doi/10.1093/oncolo/oyae349/7919584},
doi = {10.1093/oncolo/oyae349}
}