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 journalArticlepeer-review

Abstract

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)
Pages (from-to)646-652
Number of pages7
JournalGynecologic oncology
Volume158
Issue number3
DOIs
StatePublished - Sep 2020

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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