Abstract
Objectives
Frailty is a multidimensional syndrome. However, typical frailty scales used in oncology
clinics assess physical impairment and/or malnutrition but do not consider the social
domain. Our study aimed to clarify the relationship between preoperative social frailty
and overall survival (OS) and cancer-specific survival (CSS) among older patients
with gastrointestinal cancer.
Design
This was a prospective cohort study.
Setting and Participants
This single-center study recruited 195 patients with gastrointestinal cancer scheduled
for curative surgery and aged >60 years.
Methods
The outcomes considered were the OS and CSS of surgery. Primary associated factors
included frailty defined as a Geriatric 8 score ≤14; social frailty defined as 2 or
more of the following—going out less frequently, rarely visiting friends, feeling
unhelpful to friends or family, living alone, and not talking with someone daily,
and combinations therein [no frailty without social frailty (−/−), frailty without
social frailty (+/−), no frailty with social frailty (−/+), and frailty with social
frailty (+/+)]. We used the Cox proportional hazards model and the Fine and Gray proportional
subdistribution hazard model adjusting for confounding factors.
Results
Of the 195 patients, 181 (mean age, 72.0 years) were included for analysis. The median
follow-up time was 994 days. Social frailty (hazard ratio 3.10) and their combinations
[6.35; frailty with social frailty (+/+) vs no frailty without social frailty (−/−)]
were significant predictors of OS. Social frailty (subdistribution hazard ratio 3.23)
and their combinations (7.57) were significant predictors of CSS.
Conclusions and Implications
Preoperative social frailty is a predictor of OS and CSS in older patients with gastrointestinal
cancer. Screening for social frailty, frailty, and their combinations in older patients
with cancer is important.
Keywords
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Article info
Publication history
Published online: April 28, 2021
Footnotes
Funding Sources; This work was supported by the Japan Society for the Promotion of Science (JSPS) (Grant number 15K01367 and 19K11345).
The authors declare no conflicts of interest
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
