Association Between Frailty and Time Alive and At Home After Cancer Surgery Among Older Adults: A Population-Based Analysis

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  • 1 Department of Surgery, University of Toronto, Toronto, Ontario;
  • | 2 Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, Ontario;
  • | 3 ICES, Toronto, Ontario;
  • | 4 Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario;
  • | 5 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and
  • | 6 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

Background: Although frailty is known to impact short-term postoperative outcomes, its long-term impact is unknown. This study examined the association between frailty and remaining alive and at home after cancer surgery among older adults. Methods: Adults aged ≥70 years undergoing cancer resection were included in this population-based retrospective cohort study using linked administrative datasets in Ontario, Canada. The probability of remaining alive and at home in the 5 years after cancer resection was evaluated using Kaplan-Meier methods. Extended Cox regression with time-varying effects examined the association between frailty and remaining alive and at home. Results: Of 82,037 patients, 6,443 (7.9%) had preoperative frailty. With median follow-up of 47 months (interquartile range, 23–81 months), patients with frailty had a significantly lower probability of remaining alive and at home 5 years after cancer surgery compared with those without frailty (39.1% [95% CI, 37.8%–40.4%] vs 62.5% [95% CI, 62.1%–63.9%]). After adjusting for age, sex, rural living, material deprivation, immigration status, cancer type, surgical procedure intensity, year of surgery, and receipt of perioperative therapy, frailty remained associated with increased hazards of not remaining alive and at home. This increase was highest 31 to 90 days after surgery (hazard ratio [HR], 2.00 [95% CI, 1.78–2.24]) and remained significantly elevated beyond 1 year after surgery (HR, 1.56 [95% CI, 1.48–1.64]). This pattern was observed across cancer sites, including those requiring low-intensity surgery (breast and melanoma). Conclusions: Preoperative frailty was independently associated with a decreased probability of remaining alive and at home after cancer surgery among older adults. This relationship persisted over time for all cancer types beyond short-term mortality and the initial postoperative period. Frailty assessment may be useful for all candidates for cancer surgery, and these data can be used when counseling, selecting, and preparing patients for surgery.

Submitted April 7, 2022; final revision received July 5, 2022; accepted for publication July 6, 2022.

A list of the RESTORE-Cancer Group members is provided in supplemental eAppendix 1.

Previous presentation: A portion of this work was presented at the SSO 2021 – International Conference on Surgical Cancer Care Virtual Meeting; March 18–20, 2021.

Disclosures: Dr. Hallet has disclosed receiving honoraria from Ipsen, Novartis AG, AAA Pharmaceutical, Inc., Bristol Myers Squibb Company, and Medtronic. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the CIHR (grant 419955; J. Hallet) and the Ontario Institute for Cancer Research (grant 156; J. Hallet).

Disclaimer: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.

Correspondence: Julie Hallet, MD, MSc, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2-063, Toronto, ON, M4N 3M5, Canada. Email: julie.hallet@sunnybrook.ca

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