The Relationship Between Frailty and Emotional Health in Older Patients with Advanced Cancer

• Published in: The oncologist (Dayton, Ohio) Ohio), 2021-12, Vol.26 (12), p.e2181-e2191
• Main Authors: Gilmore, Nikesha, Kehoe, Lee, Bauer, Jessica, Xu, Huiwen, Hall, Bianca, Wells, Megan, Lei, Lianlian, Culakova, Eva, Flannery, Marie, Grossman, Valerie Aarne, Sardari, Ronak Amir, Subramanya, Himal, Kadambi, Sindhuja, Belcher, Elizabeth, Kettinger, Jared, O'Rourke, Mark A., Dib, Elie G., Vogelzang, Nicholas J., Dale, William, Mohile, Supriya
• Format: Article
• Language: English
• Subjects: Aged; Anxiety; Cancer patients; Demographic aspects; Depression; Distress; Emotional health; Frail elderly; Frailty; Frailty - epidemiology; Geriatric Assessment; Geriatric Oncology; Humans; Logistic Models; Mental Health; Neoplasms - complications; Neoplasms - epidemiology; Psychological aspects; Social aspects
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1002/onco.13975

Background Aging‐related deficits that eventually manifest as frailty may be associated with poor emotional health in older patients with advanced cancer. This study aimed to examine the relationship between frailty and emotional health in this population. Methods This was a secondary analysis of baseline data from a nationwide cluster randomized trial. Patients were aged ≥70 years with incurable stage III/IV solid tumors or lymphomas, had ≥1 geriatric assessment (GA) domain impairment, and had completed the Geriatric Depression Scale, Generalized Anxiety Disorder‐7, and Distress Thermometer. Frailty was assessed using a Deficit Accumulation Index (DAI; range 0–1) based on GA, which did not include emotional health variables (depression and anxiety), and participants were stratified into robust, prefrail, and frail categories. Multivariate logistic regression models examined the association of frailty with emotional health outcomes. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. Results Five hundred forty‐one patients were included (mean age: 77 years; 70–96). DAI ranged from 0.04 to 0.94; 27% of patients were classified as robust, 42% prefrail, and 31% frail. Compared with robust patients, frail patients had an increased risk of screening positive for depression (aOR = 12.8; 95% CI = 6.1–27.0), anxiety (aOR = 6.6; 95% CI = 2.2–19.7), and emotional distress (aOR = 4.62; 95% CI = 2.9–8.3). Prefrail compared with robust patients also had an increased risk of screening positive for depression (aOR = 2.22; 95% CI = 1.0–4.8) and distress (aOR = 1.71; 95% CI = 1.0–2.8). Conclusion In older patients with advanced cancer, frailty is associated with poorer emotional health, which indicates a need for an integrated care approach to treating these patients. Implications for Practice A relationship exists between frailty and poor emotional health in older adults with advanced cancer. Identifying areas of frailty can prompt screening for emotional health and guide delivery of appropriate interventions. Alternatively, attention to emotional health may also improve frailty. Frailty is an aging‐related syndrome. This article examines the relationship between frailty and emotional health in older patients with advanced cancer.