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

Nikesha Gilmore; Lee Kehoe; Jessica Bauer; Huiwen Xu; Bianca Hall; Megan Wells; Lianlian Lei; Eva Culakova; Marie Flannery; Valerie Aarne Grossman; Ronak Amir Sardari; Himal Subramanya; Sindhuja Kadambi; Elizabeth Belcher; Jared Kettinger; Mark A. O'Rourke; Elie G. Dib; Nicholas J. Vogelzang; William Dale; Supriya Mohile

doi:10.1002/onco.13975

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

Nikesha Gilmore, Lee Kehoe, Jessica Bauer, Huiwen Xu, Bianca Hall, Megan Wells, Lianlian Lei, Eva Culakova, Marie Flannery, Valerie Aarne Grossman, Ronak Amir Sardari, Himal Subramanya, Sindhuja Kadambi, Elizabeth Belcher, Jared Kettinger, Mark A. O'Rourke, Elie G. Dib, Nicholas J. Vogelzang, William Dale, Supriya Mohile

Research output: Contribution to journal › Article › peer-review

25 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	e2181-e2191
Journal	Oncologist
Volume	26
Issue number	12
DOIs	https://doi.org/10.1002/onco.13975
State	Published - Dec 2021
Externally published	Yes

Keywords

Anxiety
Depression
Distress
Emotional health
Frailty
Geriatric assessment

ASJC Scopus subject areas

Oncology
Cancer Research

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10.1002/onco.13975

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Gilmore, N., Kehoe, L., Bauer, J., Xu, H., Hall, B., Wells, M., Lei, L., Culakova, E., Flannery, M., Grossman, V. A., Sardari, R. A., Subramanya, H., Kadambi, S., Belcher, E., Kettinger, J., O'Rourke, M. A., Dib, E. G., Vogelzang, N. J., Dale, W., & Mohile, S. (2021). The Relationship Between Frailty and Emotional Health in Older Patients with Advanced Cancer. Oncologist, 26(12), e2181-e2191. https://doi.org/10.1002/onco.13975

Gilmore, N, Kehoe, L, Bauer, J, Xu, H, Hall, B, Wells, M, Lei, L, Culakova, E, Flannery, M, Grossman, VA, Sardari, RA, Subramanya, H, Kadambi, S, Belcher, E, Kettinger, J, O'Rourke, MA, Dib, EG, Vogelzang, NJ, Dale, W & Mohile, S 2021, 'The Relationship Between Frailty and Emotional Health in Older Patients with Advanced Cancer', Oncologist, vol. 26, no. 12, pp. e2181-e2191. https://doi.org/10.1002/onco.13975

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title = "The Relationship Between Frailty and Emotional Health in Older Patients with Advanced Cancer",

abstract = "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.",

keywords = "Anxiety, Depression, Distress, Emotional health, Frailty, Geriatric assessment",

author = "Nikesha Gilmore and Lee Kehoe and Jessica Bauer and Huiwen Xu and Bianca Hall and Megan Wells and Lianlian Lei and Eva Culakova and Marie Flannery and Grossman, {Valerie Aarne} and Sardari, {Ronak Amir} and Himal Subramanya and Sindhuja Kadambi and Elizabeth Belcher and Jared Kettinger and O'Rourke, {Mark A.} and Dib, {Elie G.} and Vogelzang, {Nicholas J.} and William Dale and Supriya Mohile",

note = "Publisher Copyright: {\textcopyright} 2021 AlphaMed Press.",

year = "2021",

month = dec,

doi = "10.1002/onco.13975",

language = "English (US)",

volume = "26",

pages = "e2181--e2191",

journal = "Oncologist",

issn = "1083-7159",

publisher = "Oxford University Press",

number = "12",

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TY - JOUR

T1 - The Relationship Between Frailty and Emotional Health in Older Patients with Advanced Cancer

AU - Gilmore, Nikesha

AU - Kehoe, Lee

AU - Bauer, Jessica

AU - Xu, Huiwen

AU - Hall, Bianca

AU - Wells, Megan

AU - Lei, Lianlian

AU - Culakova, Eva

AU - Flannery, Marie

AU - Grossman, Valerie Aarne

AU - Sardari, Ronak Amir

AU - Subramanya, Himal

AU - Kadambi, Sindhuja

AU - Belcher, Elizabeth

AU - Kettinger, Jared

AU - O'Rourke, Mark A.

AU - Dib, Elie G.

AU - Vogelzang, Nicholas J.

AU - Dale, William

AU - Mohile, Supriya

PY - 2021/12

Y1 - 2021/12

N2 - 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.

AB - 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.

KW - Anxiety

KW - Depression

KW - Distress

KW - Emotional health

KW - Frailty

KW - Geriatric assessment

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

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