Functional not chronologic age

Frailty index predicts outcomes in advanced ovarian cancer

Amanika Kumar, Carrie L. Langstraat, Stephanie R. DeJong, Michaela E. McGree, Jamie N Bakkum-Gamez, Amy L. Weaver, Nathan K LeBrasseur, William Arthur Cliby

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives: To assess the impact of frailty as measured by a frailty deficit index (FI) on outcomes in advanced epithelial ovarian cancer (EOC) after primary debulking surgery (PDS). Methods: Women with Stage IIIC/IV EOC who underwent PDS between 1/1/2003-12/31/2011 were included. Medical records were reviewed for patient characteristics and outcomes. The FI includes 30 items scored at 0, 0.5 or 1 and is calculated by summing across all the item scores and dividing by the total. Frailty was defined as a FI ≥. 0.15. Associations were assessed using logistic regression and Cox proportional hazards regression. Results: Of the 535 studied, 78% had stage IIIC disease and mean (SD) age was 64.3 (11.3) years. Median FI was 0.08, and 131 patients (24.5%) were considered frail with FI ≥. 0.15.Compared to non-frail patients, frail patients were more likely to have an Accordion grade 3. + complication (28.2 vs. 18.8%; odds ratio (OR): 1.70, 95% CI: 1.08-2.68) and more likely to die within 90. days of surgery (16.0 vs. 5.2%; OR: 3.48, 95% CI: 1.83-6.61). After adjusting for known risk factors, these associations remained significant, adjusted OR (aOR): 1.62, 95% CI: 1.00-2.62; aOR: 2.60, 95% CI 1.32-5.10; and aOR: 0.57, 95% CI 0.34-0.97, respectively.Overall survival (OS) for the entire cohort was 39.6. months (m). OS was shorter in the frail versus non-frail (median 26.5 vs 44.9. m, p. <. 0.001). Frailty was independently associated with death (adjusted hazard ratio: 1.52, 95% CI: 1.21-1.92) after adjusting for known risk factors. Conclusions: Frailty is a common finding in patients with EOC and is independently associated with worse surgical outcomes and poorer OS. Routine assessments of frailty can be incorporated into patient counseling and decision-making for the EOC patient beyond simple reliance on single factors such as age.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - 2017

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Ovarian Neoplasms
Odds Ratio
Survival
Ambulatory Surgical Procedures
Medical Records
Counseling
Decision Making
Logistic Models
Ovarian epithelial cancer

Keywords

  • Elderly
  • Frailty
  • Ovarian cancer
  • Sarcopenia

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Functional not chronologic age : Frailty index predicts outcomes in advanced ovarian cancer. / Kumar, Amanika; Langstraat, Carrie L.; DeJong, Stephanie R.; McGree, Michaela E.; Bakkum-Gamez, Jamie N; Weaver, Amy L.; LeBrasseur, Nathan K; Cliby, William Arthur.

In: Gynecologic Oncology, 2017.

Research output: Contribution to journalArticle

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title = "Functional not chronologic age: Frailty index predicts outcomes in advanced ovarian cancer",
abstract = "Objectives: To assess the impact of frailty as measured by a frailty deficit index (FI) on outcomes in advanced epithelial ovarian cancer (EOC) after primary debulking surgery (PDS). Methods: Women with Stage IIIC/IV EOC who underwent PDS between 1/1/2003-12/31/2011 were included. Medical records were reviewed for patient characteristics and outcomes. The FI includes 30 items scored at 0, 0.5 or 1 and is calculated by summing across all the item scores and dividing by the total. Frailty was defined as a FI ≥. 0.15. Associations were assessed using logistic regression and Cox proportional hazards regression. Results: Of the 535 studied, 78{\%} had stage IIIC disease and mean (SD) age was 64.3 (11.3) years. Median FI was 0.08, and 131 patients (24.5{\%}) were considered frail with FI ≥. 0.15.Compared to non-frail patients, frail patients were more likely to have an Accordion grade 3. + complication (28.2 vs. 18.8{\%}; odds ratio (OR): 1.70, 95{\%} CI: 1.08-2.68) and more likely to die within 90. days of surgery (16.0 vs. 5.2{\%}; OR: 3.48, 95{\%} CI: 1.83-6.61). After adjusting for known risk factors, these associations remained significant, adjusted OR (aOR): 1.62, 95{\%} CI: 1.00-2.62; aOR: 2.60, 95{\%} CI 1.32-5.10; and aOR: 0.57, 95{\%} CI 0.34-0.97, respectively.Overall survival (OS) for the entire cohort was 39.6. months (m). OS was shorter in the frail versus non-frail (median 26.5 vs 44.9. m, p. <. 0.001). Frailty was independently associated with death (adjusted hazard ratio: 1.52, 95{\%} CI: 1.21-1.92) after adjusting for known risk factors. Conclusions: Frailty is a common finding in patients with EOC and is independently associated with worse surgical outcomes and poorer OS. Routine assessments of frailty can be incorporated into patient counseling and decision-making for the EOC patient beyond simple reliance on single factors such as age.",
keywords = "Elderly, Frailty, Ovarian cancer, Sarcopenia",
author = "Amanika Kumar and Langstraat, {Carrie L.} and DeJong, {Stephanie R.} and McGree, {Michaela E.} and Bakkum-Gamez, {Jamie N} and Weaver, {Amy L.} and LeBrasseur, {Nathan K} and Cliby, {William Arthur}",
year = "2017",
doi = "10.1016/j.ygyno.2017.07.126",
language = "English (US)",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",

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T1 - Functional not chronologic age

T2 - Frailty index predicts outcomes in advanced ovarian cancer

AU - Kumar, Amanika

AU - Langstraat, Carrie L.

AU - DeJong, Stephanie R.

AU - McGree, Michaela E.

AU - Bakkum-Gamez, Jamie N

AU - Weaver, Amy L.

AU - LeBrasseur, Nathan K

AU - Cliby, William Arthur

PY - 2017

Y1 - 2017

N2 - Objectives: To assess the impact of frailty as measured by a frailty deficit index (FI) on outcomes in advanced epithelial ovarian cancer (EOC) after primary debulking surgery (PDS). Methods: Women with Stage IIIC/IV EOC who underwent PDS between 1/1/2003-12/31/2011 were included. Medical records were reviewed for patient characteristics and outcomes. The FI includes 30 items scored at 0, 0.5 or 1 and is calculated by summing across all the item scores and dividing by the total. Frailty was defined as a FI ≥. 0.15. Associations were assessed using logistic regression and Cox proportional hazards regression. Results: Of the 535 studied, 78% had stage IIIC disease and mean (SD) age was 64.3 (11.3) years. Median FI was 0.08, and 131 patients (24.5%) were considered frail with FI ≥. 0.15.Compared to non-frail patients, frail patients were more likely to have an Accordion grade 3. + complication (28.2 vs. 18.8%; odds ratio (OR): 1.70, 95% CI: 1.08-2.68) and more likely to die within 90. days of surgery (16.0 vs. 5.2%; OR: 3.48, 95% CI: 1.83-6.61). After adjusting for known risk factors, these associations remained significant, adjusted OR (aOR): 1.62, 95% CI: 1.00-2.62; aOR: 2.60, 95% CI 1.32-5.10; and aOR: 0.57, 95% CI 0.34-0.97, respectively.Overall survival (OS) for the entire cohort was 39.6. months (m). OS was shorter in the frail versus non-frail (median 26.5 vs 44.9. m, p. <. 0.001). Frailty was independently associated with death (adjusted hazard ratio: 1.52, 95% CI: 1.21-1.92) after adjusting for known risk factors. Conclusions: Frailty is a common finding in patients with EOC and is independently associated with worse surgical outcomes and poorer OS. Routine assessments of frailty can be incorporated into patient counseling and decision-making for the EOC patient beyond simple reliance on single factors such as age.

AB - Objectives: To assess the impact of frailty as measured by a frailty deficit index (FI) on outcomes in advanced epithelial ovarian cancer (EOC) after primary debulking surgery (PDS). Methods: Women with Stage IIIC/IV EOC who underwent PDS between 1/1/2003-12/31/2011 were included. Medical records were reviewed for patient characteristics and outcomes. The FI includes 30 items scored at 0, 0.5 or 1 and is calculated by summing across all the item scores and dividing by the total. Frailty was defined as a FI ≥. 0.15. Associations were assessed using logistic regression and Cox proportional hazards regression. Results: Of the 535 studied, 78% had stage IIIC disease and mean (SD) age was 64.3 (11.3) years. Median FI was 0.08, and 131 patients (24.5%) were considered frail with FI ≥. 0.15.Compared to non-frail patients, frail patients were more likely to have an Accordion grade 3. + complication (28.2 vs. 18.8%; odds ratio (OR): 1.70, 95% CI: 1.08-2.68) and more likely to die within 90. days of surgery (16.0 vs. 5.2%; OR: 3.48, 95% CI: 1.83-6.61). After adjusting for known risk factors, these associations remained significant, adjusted OR (aOR): 1.62, 95% CI: 1.00-2.62; aOR: 2.60, 95% CI 1.32-5.10; and aOR: 0.57, 95% CI 0.34-0.97, respectively.Overall survival (OS) for the entire cohort was 39.6. months (m). OS was shorter in the frail versus non-frail (median 26.5 vs 44.9. m, p. <. 0.001). Frailty was independently associated with death (adjusted hazard ratio: 1.52, 95% CI: 1.21-1.92) after adjusting for known risk factors. Conclusions: Frailty is a common finding in patients with EOC and is independently associated with worse surgical outcomes and poorer OS. Routine assessments of frailty can be incorporated into patient counseling and decision-making for the EOC patient beyond simple reliance on single factors such as age.

KW - Elderly

KW - Frailty

KW - Ovarian cancer

KW - Sarcopenia

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DO - 10.1016/j.ygyno.2017.07.126

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JO - Gynecologic Oncology

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