Measuring Frailty and Impact on Treatment

Original Article

Kenny Capps, the Founder of Throwing Bones and a warrior battling Multiple Myeloma since 2015, shared a compelling blog post highlighting the critical role of frailty in shaping the cancer treatment landscape. In this insightful article, Kenny brings attention to the conventional belief that patients with robust physical health are better equipped to endure cancer treatments, while those facing challenges like inactivity, comorbidities, and the inherent difficulties of cancer may be considered ‘frail’.

Multiple Myeloma, a cancer primarily affecting individuals in their mid-60s at the time of diagnosis, often presents unique challenges for older adults. To determine how well patients can handle treatments, various scoring indices have been developed, with the electronic frailty index (eFI) being one of the latest and most commonly used tools. The eFI evaluates patients based on 36 deficits, which includes conditions such as arthritis, atrial fibrillation, and diabetes, to gauge their ability to tolerate treatment.

Frailty assessments are typically performed at the time of diagnosis to establish a baseline but are frequently neglected throughout the ongoing journey with treatment. Dr. Hira Mian of McMaster University conducted a study involving 4,167 patients aged over 66 between 2007 and 2014. Surprisingly, over one-third of these patients were considered moderately to severely frail.

Kenny emphasizes that frailty is a crucial factor when deciding on a course of treatment. It reflects a patient's physiological competency, assessing their fitness level. Among the frailest patients in the study, common characteristics that were impacted included age, gender, ethnicity, and enrollment in Medicaid. Notably, severely frail patients received immunomodulatory drugs less frequently.

Frailty assessments are typically made at diagnosis, but they are rarely reviewed as the disease progresses or after different points throughout one’s treatment regimen. Kenny highlights the potential significance of a patient's current frailty status being monitored, suggesting it could be an indicator of overall survival.