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Hu FH, Feng LP, Jia YJ, Ge MW, Shen LT, Liu P, Chen HL. Frailty and all-cause and cancer-related mortality in cancer patients: A prospective cohort study. Eur J Oncol Nurs 2024; 71:102667. [PMID: 39003843 DOI: 10.1016/j.ejon.2024.102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To evaluate the associations between frailty and all-cause and cancer-related mortality. Additionally, the objective is to compare the magnitude of these associations between older adults and younger adults. METHODS We gathered baseline data from NHANES (1999-2018) and developed a cumulative index consisting of 39 items to evaluate frailty. The National Death Index database was utilized to track the survival status of individuals. The Cox regression model was employed to estimate the associations between frailty status and all-cause and cancer-related mortality. RESULTS Ultimately, 3398 cancer patients were included in the analysis, comprising 910 younger adults and 2488 older adults. Compared to non-frail patients, the elevated all-cause and cancer-related mortality among pre-frail patients was not statistically significant (HRs = 1.312, 95%CI: 0.956-1.800, P = 0.092; HRs = 1.462, 0.811-2.635, P = 0.207). However, a significant elevation of both all-cause and cancer-related mortality risk was observed among frail patients (HRs = 2.213, 1.617-3.030, P < 0.001; HRs = 2.463, 95%CI = 1.370-4.429, P = 0.003). Frailty individuals demonstrated a more pronounced association with the prediction of all-cause mortality in younger (HRs = 2.230, 1.073-4.634, P = 0.032) than in older adults (HRs = 2.090, 1.475-2.960, P < 0.001). Sensitivity analysis consistently revealed robust results. RCS plots suggested a progressively escalating dose-response correlation between frailty and both all-cause and cancer-related mortality risk. CONCLUSIONS Pre-frailty did not result in an increase in mortality risks compared to non-frailty. However, frailty caused a higher all-cause and cancer-related mortality risk than non-frailty. Identifying those at risk and implementing targeted interventions may contribute to extending healthy life expectancy, regardless of age.
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Affiliation(s)
- Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Li-Ping Feng
- Family-Centered Maternity Ward, Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu, China
| | - Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Peng Liu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China.
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China.
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Zhao B, Zhang S, Chen Y, Zhang T, Zhang C. Risk factors for preoperative frailty in older patients with gastric cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:450. [PMID: 38904837 DOI: 10.1007/s00520-024-08654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To summarize the available evidence on risk factors for preoperative frailty in older gastric cancer patients. METHODS We comprehensively searched the CNKI, Wanfang, VIP, CBM, PubMed, Embase, The Cochrane Library, Web of Science, and CINAHL databases for preoperative articles on risk factors for frailty in older gastric cancer patients. The search was conducted from the time of construction of the library to January 27, 2024, with no language restrictions. The quality of the included studies was rated by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality tool. RESULTS A total of 20 studies were included, including 16 cohort studies and 4 cross-sectional studies, with a total sample size of 51,717 individuals. The results of the meta-analysis showed that age, albumin, hemoglobin, cancer stage III-IV, Charlson Comorbidity Index score ≥ 3, Eastern Cooperative Oncology Group score > 2, American Society of Anesthesiologists score > 2, smoking, nutritional risk, high school degree or above, and sleep disorders are the main influencing factors for the occurrence of preoperative frailty in older gastric cancer patients. Among them, high school degree or above was a protective factor. CONCLUSIONS Our study provides valid evidence of risk factors for preoperative frailty in older patients with gastric cancer and informs clinical healthcare professionals to make targeted interventions.
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Affiliation(s)
- Bingyan Zhao
- Graduate School of Tianjin University of Chinese Medicine, Tianjin, 301617, China
| | - Siai Zhang
- Cardiac Intensive Care Unit, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Yu Chen
- Graduate School of Tianjin University of Chinese Medicine, Tianjin, 301617, China
| | - Tongyu Zhang
- Graduate School of Tianjin University of Chinese Medicine, Tianjin, 301617, China
| | - Chunmei Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
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Pelc Z, Sędłak K, Leśniewska M, Mielniczek K, Chawrylak K, Skórzewska M, Ciszewski T, Czechowska J, Kiszczyńska A, Wijnhoven BPL, Van Sandick JW, Gockel I, Gisbertz SS, Piessen G, Eveno C, Bencivenga M, De Manzoni G, Baiocchi GL, Morgagni P, Rosati R, Fumagalli Romario U, Davies A, Endo Y, Pawlik TM, Roviello F, Bruns C, Polkowski WP, Rawicz-Pruszyński K. Textbook Neoadjuvant Outcome-Novel Composite Measure of Oncological Outcomes among Gastric Cancer Patients Undergoing Multimodal Treatment. Cancers (Basel) 2024; 16:1721. [PMID: 38730672 PMCID: PMC11083243 DOI: 10.3390/cancers16091721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
The incidence of gastric cancer (GC) is expected to increase to 1.77 million cases by 2040. To improve treatment outcomes, GC patients are increasingly treated with neoadjuvant chemotherapy (NAC) prior to curative-intent resection. Although NAC enhances locoregional control and comprehensive patient care, survival rates remain poor, and further investigations should establish outcomes assessment of current clinical pathways. Individually assessed parameters have served as benchmarks for treatment quality in the past decades. The Outcome4Medicine Consensus Conference underscores the inadequacy of isolated metrics, leading to increased recognition and adoption of composite measures. One of the most simple and comprehensive is the "All or None" method, which refers to an approach where a specific set of criteria must be fulfilled for an individual to achieve the overall measure. This narrative review aims to present the rationale for the implementation of a novel composite measure, Textbook Neoadjuvant Outcome (TNO). TNO integrates five objective and well-established components: Treatment Toxicity, Laboratory Tests, Imaging, Time to Surgery, and Nutrition. It represents a desired, multidisciplinary care and hospitalization of GC patients undergoing NAC to identify the treatment- and patient-related data required to establish high-quality oncological care further. A key strength of this narrative review is the clinical feasibility and research background supporting the implementation of the first and novel composite measure representing the "ideal" and holistic care among patients with locally advanced esophago-gastric junction (EGJ) and GC in the preoperative period after NAC. Further analysis will correlate clinical outcomes with the prognostic factors evaluated within the TNO framework.
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Affiliation(s)
- Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Magdalena Leśniewska
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Katarzyna Mielniczek
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Katarzyna Chawrylak
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Magdalena Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Tomasz Ciszewski
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Joanna Czechowska
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Agata Kiszczyńska
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Bas P. L. Wijnhoven
- Department of General Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Johanna W. Van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Suzanne S. Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, 1007 MB Amsterdam, The Netherlands;
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, and Claude Huriez University Hospital, 59000 Lille, France; (G.P.); (C.E.)
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, University Lille, and Claude Huriez University Hospital, 59000 Lille, France; (G.P.); (C.E.)
| | - Maria Bencivenga
- Upper G.I. Surgery Division, University of Verona, 37126 Verona, Italy; (M.B.); (G.D.M.)
| | - Giovanni De Manzoni
- Upper G.I. Surgery Division, University of Verona, 37126 Verona, Italy; (M.B.); (G.D.M.)
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and Third Division of General Surgery, Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy;
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Vita Salute University, 20132 Milan, Italy;
| | | | - Andrew Davies
- Department of Upper Gastrointestinal and General Surgery, Guy’s and St Thomas’ Hospital, London SE1 7EH, UK;
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.E.); (T.M.P.)
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.E.); (T.M.P.)
| | - Franco Roviello
- Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Christiane Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, 50937 Cologne, Germany;
| | - Wojciech P. Polkowski
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, 20079 Lublin, Poland; (Z.P.); (K.S.); (M.L.); (K.M.); (K.C.); (M.S.); (T.C.); (J.C.); (A.K.); (W.P.P.)
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Miao X, Guo Y, Chen Y, Xu X, Ding L, Hu J, Zhao K, Lu J, Zhu H, Chen L, Zhu S, Xu Q. Exploration of frailty trajectories and their associations with health outcomes in older gastric cancer survivors undergoing radical gastrectomy: A prospective longitudinal observation study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107934. [PMID: 38160495 DOI: 10.1016/j.ejso.2023.107934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/21/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Frailty is commom among gastric cancer survivors and increases the burden of care. AIMS Our aims were to identify the frailty trajectories and investigate their associations with health outcomes in older gastric cancer survivors. METHODS We finally recruited 381 patients aged ≧60 who underwent radical gastrectomy and recorded frailty at discharge from the hospital, 1, 3, 6, and 12 months after surgery. Growth mixture modeling was used to investigate the frailty trajectories and linear regression models were used to examine their associations with health outcomes. RESULTS Three classes of frailty trajectories were identified: the "improving frailty", "maintaining frailty" and "deteriorating frailty". Compared with class 1, patients who followed class 2 and class 3 frailty trajectories were more likely to have more severe disability (β = -14.22, 95 % CI: -17.92, -10.61, P < 0.001; β = -48.34, 95 % CI: -52.25, -44.42, P < 0.001), worse quality of life (β = 10.89, 95 % CI: 7.71,14.08, P < 0.001; β = 34.82, 95 % CI: 31.46, 38.19, P < 0.001), and more frequency readmission within 1 year (β = 1.02, 95 % CI: 0.98, 1.06, P < 0.001; β = 2.10, 95 % CI: 2.01, 2.14, P < 0.001) after controlling potential confounders. However, class 2 and class 3 have no significant difference from class 1 in the total hospitalization costs (β = 1672.12, 95 % CI: -7145.95, 10496.19, P = 0.709; β = 7651.60, 95 % CI: -1670.28, 16793.47, P = 0.107). CONCLUSIONS Our study suggested the significant prognostic heterogeneity in frailty trajectories, and what we need to do is to identify patients with heterogeneous trajectory and intervene in them to reduce adverse outcomes, promote rational use of resources, and reduce the burden of care.
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Affiliation(s)
- Xueyi Miao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Yinning Guo
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Yimeng Chen
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Lingyu Ding
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Jieman Hu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Jinling Lu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Li Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
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Tang WZ, Tan ZKK, Qiu LY, Chen JQ, Jia K. Prevalence and unfavorable outcome of frailty in older adults with gastric cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:115. [PMID: 38240829 DOI: 10.1007/s00520-024-08306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND AIM Previous studies reported inconsistent results on the prevalence and prognostic implications of frailty among older adults with gastric cancer. This systematic review synthesized available literature pertaining on this topic to establish the prevalence and unfavorable outcomes of frailty in older adults with gastric cancer. METHODS A comprehensive search was conducted across multiple English databases including PubMed, Cochrane Library, CINAHL, Embase, and Web of Science as well as Chinese databases, namely, CNKI, Wan Fang, and CBM, from inception to July 4, 2023, to identify potential studies. Data related to the incidence of frailty and its unfavorable outcomes in older adults with gastric cancer were extracted. RevMan5.3 and R 4.2.2 were used to evaluate pooled prevalence, hazard ratios (HR), and 95% confidence interval (CI). RESULTS This review comprehensively selected 13 studies, comprising 9 cohort studies and 4 cross-sectional studies, on 44,117 older adults diagnosed with gastric cancer. The incidence of frailty among older adults with gastric cancer ranged from 10 to 71%. The pooled prevalence of frailty was 29% (95% CI 0.21-0.39). Frailty was found to be associated with an elevated risk of postoperative complications (HR = 1.99, 95% CI 1.45-2.73), prolonged postoperative hospital stay (HR = 2.68, 95% CI 2.38-3.02), likelihood of readmission (HR = 3.28, 95% CI 1.77-6.08), and an increased mortality risk (HR = 1.60, 95% CI 1.36-1.90). CONCLUSIONS Frailty was associated with a poor prognosis in older adults with gastric cancer. Clinical medical staff should focus on the frailty of older adults with gastric cancer, conduct large-scale, multicenter, and prospective studies and early screening of patients, and provide guidance for the implementation of prevention and treatment strategies.
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Affiliation(s)
- Wen-Zhen Tang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Zheng-Ke-Ke Tan
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Li-Yan Qiu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Jun-Qiang Chen
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
- Guangxi Clinical Research Center for Enhanced Recovery After Surgery, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumor Images, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
| | - Kui Jia
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
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Osaki T, Tatebe S, Orihara J, Uchinaka E, Ashida K, Hirooka Y, Fujiwara Y. Impact of Frailty and Sarcopenia on Short- and Long-Term Outcomes in Elderly Patients Undergoing Radical Gastrectomy for Gastric Cancer. World J Surg 2023; 47:3250-3261. [PMID: 37777671 DOI: 10.1007/s00268-023-07200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The impact of frailty and sarcopenia in patients with gastric cancer is unclear. This study aimed to comprehensively examine the impact of frailty and sarcopenia on the short- and long-term outcomes in elderly patients undergoing radical gastrectomy for gastric cancer. METHODS We retrospectively assessed 246 patients aged ≥ 65 years who underwent radical gastrectomy. Frailty and sarcopenia were assessed using the modified frailty index (mFI) and psoas muscle mass index (PMI), respectively. RESULTS There were 30 (12.2%) and 60 (24.4%) patients with High-mFI and Low-PMI, respectively. As the age increased, both sexes showed significant correlations with PMI and mFI (r = - 0.238, 0.322, P = 0.003 and 0.002, respectively). High-mFI and Low-PMI did not affect the short-term outcomes. However, High-mFI was an independent risk factor for non-home discharge (P = 0.004) and was a significant predictor of 3- and 5-year overall survival (OS) (HR = 2.76 and 2.26; P = 0.002 and 0.005, respectively) and 1-, 3- and 5-year non-cancer-specific survival (non-CSS) (HR = 4.88, 8.05, and 4.01; P = 0.017, < 0.001, < 0.001, respectively). Low-PMI was a significant predictor of only 5-year OS (HR = 2.03, P = 0.003) and non-CSS (HR = 2.10, P = 0.020). CONCLUSIONS Frailty is significant predictor of non-home discharge and 1-, 3-, 5-year OS and 3- and 5-year non-CSS. Sarcopenia is a significant predictor of 5-year OS and non-CSS. Preoperative assessment of both frailty and sarcopenia can help surgeons to select adequate treatment strategies for the elderly population.
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Affiliation(s)
- Tomohiro Osaki
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan.
| | - Shigeru Tatebe
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Junpei Orihara
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Ei Uchinaka
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Keigo Ashida
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Yasuaki Hirooka
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine Graduate, Tottori, Japan
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Zhang HP, Zhang HL, Zhou XM, Chen GJ, Zhou QF, Tang J, Zhu ZY, Wang W. Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer: An observational cohort study. World J Gastrointest Surg 2023; 15:2525-2536. [PMID: 38111763 PMCID: PMC10725547 DOI: 10.4240/wjgs.v15.i11.2525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Few studies have simultaneously compared the predictive value of various frailty assessment tools for outcome measures in patients undergoing gastrointestinal cancer surgery. Therefore, it is difficult to determine which assessment tool is most relevant to the prognosis of this population. AIM To investigate the predictive value of three frailty assessment tools for patient prognosis in patients undergoing gastrointestinal cancer surgery. METHODS This single-centre, observational, prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022. A total of 229 patients aged ≥ 18 years who underwent surgery for gastrointestinal cancer were included in this study. We collected baseline data on the participants and administered three scales to assess frailty: The comprehensive geriatric assessment (CGA), Fried phenotype and FRAIL scale. The outcome measures were the postoperative severe complications and increased hospital costs. RESULTS The prevalence of frailty when assessed with the CGA was 65.9%, 47.6% when assessed with the Fried phenotype, and 34.9% when assessed with the FRAIL scale. Using the CGA as a reference, kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale (both P < 0.001). Postoperative severe complications and increased hospital costs were observed in 29 (12.7%) and 57 (24.9%) patients, respectively. Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs (odds ratio = 2.298, 95% confidence interval: 1.044-5.057; P = 0.039). None of the frailty assessment tools were associated with postoperative severe complications. CONCLUSION The CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastrointestinal cancer.
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Affiliation(s)
- Hui-Pin Zhang
- Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, Jiangsu Province, China
- Department of Gastrointestinal Surgery, The First People’s Hospital of Changzhou, Changzhou 213000, Jiangsu Province, China
| | - Hai-Lin Zhang
- Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, Jiangsu Province, China
| | - Xiao-Min Zhou
- Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, Jiangsu Province, China
| | - Guan-Jie Chen
- Department of Invasive Technology, Zhongda Hospital Southeast University, Nanjing 210003, Jiangsu Province, China
| | - Qi-Fan Zhou
- Department of Hemopurification Center, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222061, Jiangsu Province, China
| | - Jie Tang
- Department of Hemopurification Center, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222061, Jiangsu Province, China
| | - Zi-Ye Zhu
- Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, Jiangsu Province, China
| | - Wei Wang
- Department of Gastrointestinal Surgery, The First People’s Hospital of Changzhou, Changzhou 213000, Jiangsu Province, China
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Kawai M, Demura S, Kato S, Yokogawa N, Shimizu T, Kurokawa Y, Kobayashi M, Yamada Y, Nagatani S, Uto T, Murakami H. The Impact of Frailty on Postoperative Complications in Total En Bloc Spondylectomy for Spinal Tumors. J Clin Med 2023; 12:4168. [PMID: 37373861 DOI: 10.3390/jcm12124168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Total en bloc spondylectomy (TES) is an effective treatment for spinal tumors. However, its complication rate is high, and the corresponding risk factors remain unclear. This study aimed to clarify the risk factors for postoperative complications after TES, including the patient's general condition, such as frailty and their levels of inflammatory biomarkers. We included 169 patients who underwent TES at our hospital from January 2011-December 2021. The complication group comprised patients who experienced postoperative complications that required additional intensive treatments. We analyzed the relationship between early complications and the following factors: age, sex, body mass index, type of tumor, location of tumor, American Society of Anesthesiologists score, physical status, frailty (categorized by the 5-factor Modified Frailty Index [mFI-5]), neutrophil-to-lymphocyte ratio, C-reactive protein/albumin ratio, preoperative chemotherapy, preoperative radiotherapy, surgical approach, and the number of resected vertebrae. Of the 169 patients, 86 (50.1%) were included in the complication group. Multivariate analysis showed that high mFI-5 scores (odds ratio [OR] = 2.99, p < 0.001) and an increased number of resected vertebrae (OR = 1.87, p = 0.018) were risk factors for postoperative complications. Frailty and the number of resected vertebrae were independent risk factors for postoperative complications after TES for spinal tumors.
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Affiliation(s)
- Masafumi Kawai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Yuki Kurokawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Motoya Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Yohei Yamada
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoshi Nagatani
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takaaki Uto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
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Morgagni P, Monti M, Solaini L, Foca F, Ercolani G. Frail patients dropping out of neoadjuvant treatment: what should we do? Updates Surg 2023; 75:403-408. [PMID: 36462144 DOI: 10.1007/s13304-022-01422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022]
Abstract
Perioperative oncological treatment is currently the gold standard approach in Europe for Advanced Gastric Cancer patients. Unfortunately, patients dropping out due to worsening conditions has been frequently observed, but these data are seldomly considered and reported. To analyze frequency and propose solutions to support these patients, we reconsidered our results from the GASTRODOC randomized trial performed by [blinded for reviewers] and GIRCG on 91 patients. Thirty-four patients (37.4%) suspended chemotherapy and five (5.4%) did not reach surgery. Ten patients (11%) presented unacceptable toxicity related to gastrointestinal symptoms, six ended the treatment for investigator decision and six for progression, five patients withdrew their consent, five patients were excluded because of surgical complications and long hospitalization, and two patients died. Even though not significant, survival rates for patients who interrupted treatment in the whole trial were lower (5-year OS completed 64.6 vs. interrupted 41.8 p 0.07). Promptness in giving patient support for gastrointestinal symptoms, careful evaluation of anemia and patient nutritional status, and psychological programs from the beginning of the oncologic treatment may improve the final results.
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Affiliation(s)
- Paolo Morgagni
- General and Oncologic Surgery, "Morgagni-Pierantoni" Hospital, Forlì, FC, Italy
| | - Manlio Monti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, Italy.
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, University of Bologna, "Morgagni-Pierantoni" Hospital, Forlì, FC, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romanolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, "Morgagni-Pierantoni" Hospital, Forlì, FC, Italy
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Wang X, Sun Y, Wang P, Jie Y, Liu G, Gong D, Fan Y. Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis. Front Oncol 2022; 12:972287. [PMID: 36387139 PMCID: PMC9659614 DOI: 10.3389/fonc.2022.972287] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Frailty as a common geriatric syndrome can affect the clinical outcomes in patients with gastric cancer. However, the impact of frailty on survival and readmission patients with gastric cancer has not been well-characterised. Objectives To investigate the impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy by conducting a meta-analysis. Methods Eligible studies were identified by searching the PubMed, Web of Science, Cochrane Library, and Embase databases until 2 September 2022. Observational studies that evaluated the value of frailty in predicting adverse outcomes in gastric cancer patients undergoing gastrectomy were included. The outcomes of interest were overall survival, disease-specific survival (death from gastric cancer), and readmission. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled to calculate the association of frailty with adverse outcomes. Results Eight studies reported on nine articles with 2,792 patients with gastric cancer were included. A fixed-effect meta-analysis indicated that frailty was associated with a reduced in-hospital overall survival (HR 2.08; 95% CI 1.46–2.95), long-term overall survival (HR 1.84; 95% CI 1.37–2.47), and disease-specific survival (HR 1.94; 95% CI 1.34–2.83). In addition, frailty was associated with increased risk of readmission within 1 year (HR 3.63; 95% CI 1.87–7.06). Conclusions Frailty was associated with a reduced overall survival and disease-specific survival and an increased risk of readmission in patients with gastric cancer undergoing gastrectomy. Frail status may play an important role in the risk stratification of gastric cancer after gastrectomy.
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Affiliation(s)
- Xiaoyan Wang
- Department of Gastroenterology, The Suqian Clinical College of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Yimeng Sun
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Pei Wang
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yu Jie
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Guodong Liu
- Department of General Surgery, The Suqian Clinical College of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Dandan Gong
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
- *Correspondence: Yu Fan, ; Dandan Gong,
| | - Yu Fan
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
- *Correspondence: Yu Fan, ; Dandan Gong,
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