Impact of frailty on outcomes in elderly pancreatic cancer patients undergoing chemotherapy: A National Inpatient Sample analysis.

Abstract

e16398 Background: The healthcare burden of pancreatic cancer in the United States is exponentially growing, with an added impact on the elderly population. Although recent studies have suggested that frailty may impact the therapeutic outcomes of several cancers, large-scale data on its role among PC patients undergoing chemotherapy is lacking. We propose to bridge this gap through the National Inpatient Sample (NIS) analysis, which aims to aid in risk stratification and improved surveillance during hospitalizations for developing these complications. Methods: We analyzed NIS data between 2016 and 2022 for PC patients aged > 60 who were admitted for chemotherapy. Frailty was assessed using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator list. Frail patients were compared to non-frail patients to evaluate differences in demographics and in-hospital complications. Results: Of the 6625 PC adults older than 60 years who were admitted for chemotherapy, 44.5%(2945 patients) were classified as frail. The number of patients in the non-frail group included more females(50.3%), while in the frail group, 51.6% were males. However, this was not significant (p = 0.127). The frail group reported a higher mean age of 70.11 years (vs. 69.17 years, p < 0.01). An estimated 22.9% of the frail group was on palliative care, while it involved only 9.2% among the non-frail patients(p < 0.01). Several complications were more common among our frail cohort, including gastrointestinal bleeding(aOR 1.495, 95% CI 1.192-1.875, p < 0.01), sepsis(aOR 1.406, 95% CI 1.169-1.691, p < 0.01), hypotension(aOR 1.555, 95% CI 1.237-1.956, p < 0.01), acute kidney injury(AKI)(aOR 1.683, 95% CI 1.469-1.928, p < 0.01), and all-cause death(aOR 1.338, 95% CI 1.038-1.725, p = 0.025). Events of chemotherapy induced agranulocytosis(aOR 1.196, 95% CI 0.910-1.571, p = 0.199), acute liver failure(aOR 1.177, 95% CI 0.744-1.860, p = 0.486), and intensive care unit(ICU) admission(aOR 1.201, 95% CI 0.939-1.537, p = 0.145) were similar. Conclusions: Frailty in PC patients undergoing chemotherapy is associated with poorer outcomes, including increased mortality. These findings emphasize the need to consider risk stratification for complications in this patient population, aiding in developing frailty-driven management protocols to improve chemotherapy outcomes. These measures can help improve the quality of care for frail PC patients undergoing chemotherapy and reduce the healthcare burden of managing these complications.