Frailty is a determinant of suboptimal chemotherapy in women with advanced ovarian cancer

Deepa Maheswari Narasimhulu, Michaela E. McGree, Amy L. Weaver, Aminah Jatoi, Nathan K LeBrasseur, Gretchen E. Glaser, Carrie L. Langstraat, Matthew S. Block, Amanika Kumar

Research output: Contribution to journalArticle


Objective: To evaluate the relationship between frailty and chemotherapy delivery among women with epithelial ovarian cancer (EOC). Methods: We included women who underwent primary debulking surgery (PDS) for stage IIIC/IV EOC between 1/2/2003 and 12/30/2011, received adjuvant chemotherapy at our institution, and had data available to calculate a frailty deficit index. Frailty was defined as a frailty deficit index ≥0.15. Relative dose intensity (RDI) of chemotherapy was calculated as the percentage of the standard dose that was administered, and compared between frail and non-frail using the Wilcoxon rank-sum test. Results: Failure to receive chemotherapy following PDS was twice as common among frail vs. non-frail women (26.7% vs 14.2%, p = 0.001). Of the 169 women who received chemotherapy at our institution, 17.2% (29/169) were frail. Frail women were older (mean, 67.9 vs 62.3 years, p = 0.01), had higher BMI (mean, 29.6 vs 25.7 kg/m2, p = 0.003), and were less likely to complete 6 cycles of chemotherapy (75.9 vs. 93.6%, p = 0.008). Using an RDI cutoff of 85%, frail women were less likely to have adequate doses of carboplatin (15.8 vs. 66.2%, p < 0.001) and paclitaxel (57.9 vs. 80.5%, p = 0.07) despite no differences in dose delays (34.5 vs. 42.1%), dose reductions (65.5 vs. 68.6%), and severe neutropenia (44.8 vs. 39.3%). After adjusting for age, frailty was associated with shorter progression-free (HR 1.58, 95% CI: 0.99–2.50) and overall survival (HR 2.14, 95% CI: 1.35–3.41). Conclusion: Frail women with EOC were less likely to receive chemotherapy or the optimal dose of chemotherapy after PDS despite no evidence of treatment-related toxicity. Frail EOC patients demonstrated shorter progression-free and overall survival. Further studies are needed to explore the association between frailty, chemotherapy, and survival.

Original languageEnglish (US)
JournalGynecologic oncology
StateAccepted/In press - Jan 1 2020


  • Chemotherapy
  • Frailty
  • Frailty index
  • Ovarian cancer
  • Relative dose intensity

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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