Frailty based on the Memorial Sloan Kettering Frailty Index is associated with surgical decision making, clinical trial participation, and overall survival among older women with ovarian cancer Journal Article


Authors: Filippova, O. T.; Tin, A. L.; Alonso, J.; Vickers, A. J.; Tew, W. P.; Gardner, G. J.; Sonoda, Y.; Long Roche, K.; Zivanovic, O.; Chi, D. S.; Shahrokni, A.
Article Title: Frailty based on the Memorial Sloan Kettering Frailty Index is associated with surgical decision making, clinical trial participation, and overall survival among older women with ovarian cancer
Abstract: Objectives: To determine whether the Memorial Sloan Kettering Frailty Index (MSK-FI) is associated with decision-making in older women surgically treated for advanced-stage ovarian cancer. Methods: We retrospectively applied the MSK-FI to women ≥70 years with newly diagnosed advanced-stage ovarian cancer surgically treated at our institution from 01/2001–05/2017. MSK-FI components, including 10 comorbidities and functional assessment, were extracted from medical records. The MSK-FI ranges from 0 to 11, with higher scores indicating greater frailty. The primary outcome was the association between frailty and rate of primary debulking surgery (PDS), for which a multivariable logistic regression was used, adjusted for stage and histology. Results: We identified 430 women treated with PDS (n = 231, 54%) or neoadjuvant chemotherapy/interval debulking (n = 199, 46%) with complete data. MSK-FI score distribution was: “0”, 95 patients (22%); “1”, 172 (40%); “2”, 89 (21%); and “3+”, 74 (17%). More-frail patients were less likely to have undergone PDS (OR for a unit increase of MSK-FI: 0.64; 95%CI, 0.53–0.77; p < 0.0001). Grade 3+ complications and unintended intensive care admission occurred in 40 (9%) and 38 (9%) women, respectively, but were not associated with frailty (OR 1.21; 95%CI, 0.96–1.52; p = 0.11). More-frail patients were more likely to delay postoperative chemotherapy (non-linear association p = 0.009) and less likely to enroll in research (OR 0.84; 95%CI, 0.70–1.00; p = 0.049). Greater frailty was associated with poorer overall survival (HR 1.16; 95%CI, 1.05–1.30; p = 0.005). Conclusions: Frailty, as calculated by the MSK-FI, is strongly associated with treatment approach in older women with advanced ovarian cancer, suggesting objective or subjective correlates of the MSK-FI influence decision-making. © 2021 Elsevier Inc.
Keywords: ovarian cancer; surgery; neoadjuvant chemotherapy; frailty; frailty index; msk-fi
Journal Title: Gynecologic Oncology
Volume: 161
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2021-06-01
Start Page: 687
End Page: 692
Language: English
DOI: 10.1016/j.ygyno.2021.03.016
PUBMED: 33773807
PROVIDER: scopus
PMCID: PMC8164977
DOI/URL:
Notes: Article -- Export Date: 1 July 2021 -- Source: Scopus
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MSK Authors
  1. Ginger J Gardner
    200 Gardner
  2. Dennis S Chi
    585 Chi
  3. Yukio Sonoda
    361 Sonoda
  4. Oliver Zivanovic
    203 Zivanovic
  5. Andrew J Vickers
    671 Vickers
  6. Kara Christine Long
    133 Long
  7. William P Tew
    189 Tew
  8. Amy Lam Ling Tin
    41 Tin