Frailty in Long-Term Prostate Cancer Survivors and Its Association With Quality of Life and Emotional Health

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Valentin H. Meissner Department of Urology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany

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Kolja Imhof Department of Urology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany

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Matthias Jahnen Department of Urology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany

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Lukas Lunger Department of Urology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany

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Andreas Dinkel Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany

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Stefan Schiele Department of Urology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany

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Donna P. Ankerst Departments of Mathematics and Life Science Systems, Munich Data Science Institute, Technical University of Munich, Garching, Germany

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Jürgen E. Gschwend Department of Urology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany

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Kathleen Herkommer Department of Urology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany

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Background: Frailty is emerging as an important determinant for quality of life (QoL) and emotional health in older patients with cancer, and specifically in long-term prostate cancer survivors, but quantitative studies are lacking. The current study assesses the prevalence of frailty and its association with QoL and emotional health in long-term prostate cancer survivors after radical prostatectomy. Patients and Methods: A total of 2,979 prostate cancer survivors from the multicenter German Familial Prostate Cancer cohort completed questionnaires on frailty (Groningen Frailty Indicator [GFI]), QoL (EORTC QoL Questionnaire-Core 30), and emotional health (anxiety/depression symptoms via the Patient Health Questionnaire-4). Modified Poisson regression analysis was used to assess factors associated with frailty. Results: Average patient age was 79.4 years [SD, 6.4 years] and average time since radical prostatectomy was 17.4 years [SD, 3.8 years]. Among the cohort, 33.1% (n=985) of patients were classified as frail (GFI ≥4). Frail patients reported worse emotional health than nonfrail patients (depression symptoms: 24.0% vs 4.0%; anxiety symptoms: 20.6% vs 2.0%; both P<.001) and lower QoL (mean [SD], 53.4 [19.2] vs 72.7 [16.0]); P<.001). Higher age (relative risk [RR], 1.02; 95% CI, 1.01–1.03) and worse depressive (RR, 1.18; 95% CI, 1.12–1.24) and anxiety symptoms (RR, 1.17; 95% CI, 1.11–1.23) were associated with frailty. Living in a partnership (RR, 0.76; 95% CI, 0.67–0.86) and a higher QoL (RR, 0.86 for a 10-point increase; 95% CI, 0.84–0.89) were associated with nonfrailty. Conclusions: In a large German cohort, every third long-term prostate cancer survivor after radical prostatectomy was frail. The association of frailty with lower QoL and poorer mental health indicates the need for an integrated care approach including further geriatric assessment and possible interventions to improve health outcomes targeted to frail patients.

Submitted April 6, 2024; final revision received August 7, 2024; accepted for publication August 9, 2024. Published online December 11, 2024.

Author contributions: Conceptualization: Meissner, Dinkel, Herkommer. Data curation: Imhof. Formal analysis: Schiele, Ankerst. Investigation: Meissner, Herkommer. Methodology: Meissner, Schiele, Ankerst, Herkommer. Project administration: Meissner, Herkommer. Software: Schiele. Supervision: Gschwend, Herkommer. Validation: Meissner, Jahnen, Lunger, Dinkel. Writing—original draft: Meissner. Writing—review & editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7066. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.

Correspondence: Valentin H. Meissner, MD, Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany. Email: valentin.meissner@tum.de

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