Frailty index could identify indications for urologic Ca surgery

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A new frailty assessment tool can aid in the prognosis of urologic cancer patients, its inventors say.

"It can identify the indications for surgery," said Shingo Hatakeyama, MD, of Hirosaki University in Hirosaki, Japan.

Frailty can be difficult to define, said Dr. Hatakeyama's co-author and colleague at Hirosaki University, Soma Osamu, who presented the findings at the AUA annual meeting in San Francisco. He said previous models have shortcomings.

Fried et al defined frailty as a clinical syndrome in which three or more of the following criteria are present: unintentional weight loss, self-reported exhaustion, weakness in grip strength, slow walking speed, and low physical activity.

But this model may be simplistic, said Osamu. Previous authors have noted that participants in the study performed by Fried and colleagues were younger, less likely to report limitations in activity, less likely to have high blood pressure and stroke, and more likely to perceive their health status as very good or excellent than people those who were ineligible or who refused to participate.

The model proposed by Rockwood et al uses dozens of variables, including changes in everyday activities, head and neck problems, problems getting dressed, poor muscle tone, and myocardial infarction. This approach is too complex, said Osamu.

The authors of the current study created their own index by assessing 605 urologic cancer patients who presented at their office. They chose handgrip strength and gait speed, hemoglobin, albumin, renal function, exhaustion, and depression as their criteria. They selected controls from 2,280 community-dwelling subjects.

They compared frailty variables between pair-matched controls and urologic cancer patients. Using this data, they developed a frailty discriminant score (FDS), and calculated its influence on overall survival.

Next:What the authors foundGait speed, hemoglobin, serum albumin, exhaustion, and depression were significantly worse in patients with all types of cancers than in the pair-matched controls.

Among patients with bladder, upper tract urothelial carcinoma, and renal cell carcinoma, overall survival was significantly shorter in patients with an FDS over 2.30 than in those with a lower score.

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Among patients with prostate cancer, overall survival was significantly shorter in patients with an FDS over 3.30 than in those with a lower score.

Patients with a 0 on the sum of positive components in the Fried criteria scored an FDS of 1.75. A Fried of 1 corresponded to an FDS of 3.28, a Fried of 2 corresponded to an FDS of 3.74, and a Fried of 3 corresponded to an FDS of 6.73. The differences were statistically significant (p<.001).

The tool can help patients and physicians make more informed decisions, Dr. Hatakeyama said. Based on such findings, a surgeon might decide not to perform a procedure, he said.

"We need more data, but it suggests that possibility,” said Dr. Hatakeyama.