The association between frailty and time alive and at home after cancer surgery among older adults: a populationbased analysis

• Published in: Canadian Journal of Surgery Vol. 64; pp. S87 - S88
• Main Authors: Zuckerman, J, Haas, B, Tillman, B, Guttman, M, Chesney, T, Zuk, V, Mahar, A, Hsu, A, Chan, W, Vasdev, R, Coburn, N, Hallet, J
• Format: Journal Article
• Language: English
• Published: Ottawa CMA Impact, Inc 01.12.2021
• Subjects: Cancer surgery; Frailty; Older people
• ISSN: 0008-428X; 1488-2310

Background: Long-term functional outcomes are central to older adults' decision-making regarding cancer treatments. While frailty is known to affect short-term postoperative outcomes, its impact on long-term functional decline after cancer surgery is unknown. We examined the association between frailty and remaining alive and at home after cancer surgery among older adults. Methods: In this population-based study, we included adults 70 years of age and older who had a cancer diagnosis and underwent resection (2007-2017). The probability of remaining alive and at home (i.e., not admitted to a nursing home) in the five years after cancer resection was evaluated with Kaplan-Meier methods. Extended Cox regression with timevarying effects examined the association between frailty and remaining alive and at home. Results: Of 82 037 patients, 6443 (7.8%) had preoperative frailty. With median follow-up of 47 months (interquartile range 23-81), patients with frailty had a significantly lower probability of remaining alive and at home 5 years after cancer surgery (39.1%, 95% confidence interval [CI] 37.8%-40.4%) compared with those without frailty (62.5%, 95% CI 62.1%-63.9%). After adjustment, frailty remained associated with increased hazards of not remaining alive and at home. This increase was highest 31 to 90 days after surgery (hazard ratio [HR] 2.00, 95% CI 1.78-2.24) and remained significantly elevated beyond 1 year after surgery (HR 1.56, 95% CI 1.48-1.64). This pattern was observed across cancer sites, including breast and melanoma. Conclusion: Preoperative frailty was independently associated with a decreased probability of remaining alive and at home after cancer surgery among older adults. This relationship persisted over time for all cancer types, beyond short-term mortality and the initial postoperative period. Frailty should be assessed in all candidates for cancer surgery, and these data should be used when counselling, selecting and preparing patients for surgery.