Does frailty modulate the predictive value of performance status in older adults with cancer?

Abstract

e13844 Background: Cancer treatments are not a one-size-fits-all approach, and even when age is a well-known risk factor for developing malignant neoplasms, treatment options for older patients are under-researched. The latter often leads to poorer outcomes when added to age-related vulnerability. While frailty has been shown to influence outcomes in older patients with cancer, it remains unclear whether it alters the predictive value of performance status (PS) and days in bed (DIB) in assessing mortality risk. This study aims to investigate whether frailty modifies the association of PS and DIB with mortality in older adults with cancer. Methods: This is a secondary analysis of the Mexican Health and Aging Study (MHAS), a nationally representative cohort of individuals aged 50 years or older. Data was extracted from the baseline assessment in 2001 and follow-up data available for the years 2003, 2012, 2015, 2018 and 2021. Cancer status, performance status, frailty index, and social vulnerability were included as key variables. Mortality risk was assessed using Cox regression and Kaplan-Meier analyses, with interaction terms between frailty and PS. All analyses were conducted using STATA 18.0. Results: The study sample included 318 individuals (mean age 68.02 years, 62.57% women). Frailty index, performance status, and social vulnerability were associated with mortality in those with low frailty levels. Specifically, for individuals with low frailty, higher PS scores (HR 5.46) and higher social vulnerability (HR 234.79) were significant predictors of mortality. However, in frail individuals, the association of PS with mortality was lost. Conclusions: Frailty significantly modifies the relationship between performance status and mortality risk in older patients with cancer. In frail individuals, traditional performance status measures may not adequately predict mortality, highlighting the need for comprehensive geriatric assessments in this population. In settings with limited access to formal geriatric assessments, frailty evaluation may be an essential first step to better assess cancer prognosis in older adults.