Frailty Parameters, Morbidity and Mortality in Older Adults with Cancer: A Structural Equation Modelling Approach Based on the Fried Phenotype
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Population
2.2. Cancer-Related and Demographic Data
2.3. Geriatric Assessment (GA)
2.4. Definition of Frailty
3. Covariates
3.1. Adverse Health Outcomes
3.2. Prespecified Structural Equation Modelling (SEM) of the Frailty Phenotype
3.3. Statistical Analyses
4. Results
4.1. Patients
4.2. Baseline Characteristics of Patients and the Frailty Phenotype
4.3. Correlations between Frailty Criteria and the Other Observed Variables
4.4. Goodness of Fit
4.5. Pathways of the Frailty Phenotype Leading to Mortality
4.6. Frailty Phenotype Pathways Leading to Morbidity
5. Discussion
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Variables | n (%) or Median [IQR] |
---|---|
Age (year) | 82 [77–86] |
Sex (female) | 323 (54) |
Frailty phenotype (yes) | 352 (58) |
Cancer site | |
Colorectal | 109 (18) |
Breast | 105 (17) |
Lung | 92 (15) |
Liver | 85 (14) |
Digestive tract other than colorectal a | 79 (13) |
Genito-urinary tract | 40 (7) |
Haematological malignancies | 34 (6) |
Skin with melanoma | 16 (2.5) |
Prostatic | 16 (2.5) |
Others b | 27 (5) |
Cancer extension | |
Local | 104 (17) |
Locally advanced | 228 (38) |
Metastatic | 271 (45) |
Supportive care only (yes) | 124 (20.5) |
Comorbidities (CIRS(G)): | |
Total >14 | 269 (45) |
Dependence | |
ADL £ 5/6 | 204 (34) |
IADL £ 3/4 | 386 (64) |
Nutrition | |
BMI < 21 kg/m2 | 84 (14) |
Serum albumin level < 35 g/L | 221 (37) |
Serum CRP ≥ 10 mg/L | 267 (44) |
Mobility | |
SPPB < 9/12 | 314 (52) |
One-leg stance balance < 5 s | 448 (74) |
Mood | |
Mini-GDS ≥ 1/4 | 261 (44) |
Missing data | 6 (1) |
Cognition | |
MMSE < 24/30 | 217 (51) |
Missing data | 174 (29) |
Shrinking (Yes) | Exhaustion (Yes) | Low Physical Activity (Yes) | Slowness (Yes) | Weakness (Yes) | One-Leg Stance < 5 s (Yes) | SPPB < 9/12 (Yes) | BMI < 21 kg/m2 (Yes) | Albumin < 35 g/L (Yes) | CRP ≥ 10 mg/L (Yes) | Age ≥ 82 Years (Yes) | CIRS(G) Total > 14 (Yes) | Cancer Site | Cancer Extension | Supportive Care Only (Yes) | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Shrinking (yes) | 1 | ||||||||||||||
Exhaustion (yes) | 0.24 * | 1 | |||||||||||||
Low physical Activity (yes) | 0.13 * | 0.13 * | 1 | ||||||||||||
Slowness (yes) | 0.10 * | 0.31 * | 0.27 * | 1 | |||||||||||
Weakness (yes) | 0.06 | 0.18 * | 0.23 * | 0.34 * | 1 | ||||||||||
One-leg stance < 5 s (yes) | 0.06 | 0.15 * | 0.33 * | 0.37 * | 0.35 * | 1 | |||||||||
SPPB < 9/12 (yes) | 0.09 * | 0.29 * | 0.29 * | 0.75 * | 0.38 * | 0.50 * | 1 | ||||||||
BMI < 21 kg/m2 (yes) | 0.18 * | 0.18 * | 0.04 | 0.05 | 0.03 | 0.06 | 0.03 | 1 | |||||||
Serum albumin < 35 g/L (yes) | 0.22 * | 0.20 * | 0.10 * | 0.21 * | 0.14 * | 0.13 * | 0.20 * | 0.17 * | 1 | ||||||
Serum CRP ≥ 10 mg/L (yes) | 0.20 * | 0.12 * | 0.08 * | 0.05 | 0.05 | 0.06 | 0.06 | 0.09 * | 0.30 * | 1 | |||||
Age ≥ 82 years (yes) | 0.06 | 0.05 | 0.08 * | 0.16 * | 0.15 * | 0.20 * | 0.24 * | 0.09 * | 0.04 | 0.003 | 1 | ||||
CIRS(G) total > 14 (yes) | 0.01 | 0.05 | 0.11 * | 0.25 * | 0.15 * | 0.19 * | 0.25 * | 0.11 * | 0.11 * | 0.10 * | 0.14 * | 1 | |||
Cancer site | 0.30 * | 0.12 | 0.15 | 0.21 * | 0.14 | 0.14 | 0.20 * | 0.15 | 0.20 * | 0.25 * | 0.19 * | 0.12 | 1 | ||
Cancer extension | 0.08 | 0.05 | 0.02 | 0.02 | 0.02 | 0.04 | 0.02 | 0.02 | 0.04 | 0.15 * | 0.09 | 0.02 | 0.24 * | 1 | |
Supportive care only (yes) | 0.03 | 0.15 * | 0.08 * | 0.25 * | 0.17 * | 0.14 * | 0.23 * | 0.09 * | 0.13 * | 0.05 | 0.14 * | 0.09 * | 0.23 * | 0.08 | 1 |
Models | Estimate | Standard Error | Standardized Coefficient (β Coefficient) | p Value |
---|---|---|---|---|
Model 1 | ||||
Sarcopenia~CIRS(G) total > 14 | 0.64 | 0.1 | 0.30 | <0.0001 |
Exhaustion~sarcopenia | 0.47 | 0.06 | 0.47 | <0.0001 |
Cachexia~exhaustion | 0.16 | 0.05 | 0.37 | 0.001 |
Mortality * | ||||
~ sarcopenia | 0.18 | 0.07 | 0.18 | 0.01 |
~ cachexia | 1.30 | 0.29 | 0.52 | <0.0001 |
~ cancer site | 0.05 | 0.02 | 0.13 | 0.03 |
~ cancer extension | 0.23 | 0.07 | 0.20 | <0.0001 |
Supportive care only ~ sarcopenia | 0.44 | 0.06 | 0.45 | <0.0001 |
Model 2 | ||||
Sarcopenia ~ CIRS(G) total > 14 | 0.64 | 0.1 | 0.30 | <0.0001 |
Exhaustion ~ sarcopenia | 0.47 | 0.06 | 0.48 | <0.0001 |
Cachexia ~ exhaustion | 0.17 | 0.05 | 0.41 | <0.0001 |
Morbidity * | ||||
~ sarcopenia | 0.36 | 0.06 | 0.37 | <0.0001 |
~ cachexia | 0.46 | 0.20 | 0.19 | 0.02 |
~ cancer site | 0.05 | 0.02 | 0.14 | 0.01 |
~ cancer extension | 0.06 | 0.06 | 0.06 | 0.28 |
Supportive care only ~ sarcopenia | 0.44 | 0.06 | 0.45 | <0.0001 |
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Pamoukdjian, F.; Laurent, M.; Martinez-Tapia, C.; Rolland, Y.; Paillaud, E.; Canoui-Poitrine, F. Frailty Parameters, Morbidity and Mortality in Older Adults with Cancer: A Structural Equation Modelling Approach Based on the Fried Phenotype. J. Clin. Med. 2020, 9, 1826. https://doi.org/10.3390/jcm9061826
Pamoukdjian F, Laurent M, Martinez-Tapia C, Rolland Y, Paillaud E, Canoui-Poitrine F. Frailty Parameters, Morbidity and Mortality in Older Adults with Cancer: A Structural Equation Modelling Approach Based on the Fried Phenotype. Journal of Clinical Medicine. 2020; 9(6):1826. https://doi.org/10.3390/jcm9061826
Chicago/Turabian StylePamoukdjian, Frederic, Marie Laurent, Claudia Martinez-Tapia, Yves Rolland, Elena Paillaud, and Florence Canoui-Poitrine. 2020. "Frailty Parameters, Morbidity and Mortality in Older Adults with Cancer: A Structural Equation Modelling Approach Based on the Fried Phenotype" Journal of Clinical Medicine 9, no. 6: 1826. https://doi.org/10.3390/jcm9061826