The impact of the modified frailty index on clinical outcomes for patients with stage IV non-small cell lung cancer receiving chemotherapy

Shivani Mathur; Laura Prince; Oliver Bucher; Lin Xue; Shantanu Banerji; David E Dawe

doi:10.1016/j.jgo.2022.02.015

The impact of the modified frailty index on clinical outcomes for patients with stage IV non-small cell lung cancer receiving chemotherapy

J Geriatr Oncol. 2022 Jun;13(5):654-661. doi: 10.1016/j.jgo.2022.02.015. Epub 2022 Mar 4.

Authors

Shivani Mathur¹, Laura Prince¹, Oliver Bucher², Lin Xue², Shantanu Banerji³, David E Dawe⁴

Affiliations

¹ Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
² Department of Epidemiology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
³ Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: ddawe@cancercare.mb.ca.

PMID: 35249851
DOI: 10.1016/j.jgo.2022.02.015

Abstract

Introduction: Frailty impacts outcomes for patients with lung cancer, but no brief tools have been assessed in patients with metastatic disease. We evaluated the impact of the Modified Frailty Index (mFI) on clinical outcomes for patients with metastatic non-small cell lung cancer (NSCLC).

Methods: We conducted a retrospective cohort study of all patients with Stage IV NSCLC diagnosed in Manitoba between 2011 and 2016 who then received first-line cytotoxic chemotherapy. We assigned mFI scores based on documented comorbidities and collected data on toxicity, progression, and survival. Descriptive statistics characterized the cohort and toxicity experienced. Kaplan-Meier methods were used to evaluate progression-free survival (PFS) and overall survival (OS), followed by multivariable Cox proportional hazards models.

Results: Our cohort of 426 (mFI 0/1-2/3+ = 175/196/55) patients, showed no significant association between higher mFI score and incidence of overall chemotherapy toxicity. Patients with mFI 0 experienced more frequent thromboses (p=0.022) and a trend towards less nausea or vomiting (p = 0.059). There was no significant difference in PFS or OS among frailty groups. Poorer performance status, number of metastatic sites, and the absence of a driver mutation were independently associated with poorer PFS and OS. Male sex and not completing chemotherapy were also associated with worse OS.

Conclusion: This study is the first to investigate the use of the mFI as a frailty tool in patients with metastatic NSCLC receiving cytotoxic chemotherapy. The mFI does not appear to be strongly associated with treatment-related toxicities, PFS, or OS in patients with metastatic NSCLC receiving first-line cytotoxic chemotherapy.

Keywords: Cytotoxic chemotherapy; Frailty; Outcomes research; Prognosis; Toxicity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / adverse effects
Carcinoma, Non-Small-Cell Lung* / pathology
Frailty* / complications
Humans
Lung Neoplasms* / pathology
Male
Proportional Hazards Models
Retrospective Studies