Oncogeriatrics (part 1.). Frailty in older adults with cancer

Abstract

About onehalf of cancer cases and two-thirds of cancer deaths occur in patients 65 years of age or older. Therefore, understanding the health status of an older patient is just as important as staging of the cancer.
Frailty is a complex, multidimensional syndrome of increased vulnerability and loss of adaptive capacity/resistance to external stressors, resulting in an increased risk of adverse outcomes. Clinical presentation is non-specific: fatigue, unexplained weight loss, frequent infections, decline in physical mobility/balance/gait speed. Therefore, the routine format of preoperative investigations often does not allow for adequate frailty identification. There are two principal models of frailty: the phenotype model and the accumulation of deficits model. There is no consensus on an operational definition of frailty. However, it has been demonstrated that frailty, not chronological age, is the most important risk factor for poor outcome. Therefore, frailty identification should be obligatory before the beginning of the oncologic treatment.