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Frailty assessment prior to thoracic surgery for lung or esophageal cancer: a feasibility study

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Abstract

Background

Frailty assessment has not been thoroughly assessed in thoracic surgery. Our primary objective was to assess the feasibility of comprehensive frailty testing prior to lung and esophageal surgery for cancer. The secondary objective was to assess the utility of frailty indices in risk assessment prior to thoracic surgery.

Methods

Prospectively recruited patients completed multiple physiotherapy tests (6-min walk, gait speed, hand-grip strength), risk stratification (Charlson Comorbidity Index, Revised Cardiac Risk Index, Modified Frailty Index), and quality of life questionnaires. Lean psoas area was also assessed by a radiologist using positron emission tomography/computed tomography scans. Data was analyzed using Fisher’s exact, Mann-Whitney U and independent t tests.

Results

The feasibility of comprehensive frailty assessment was assessed over a 4-month period among 40 patients (esophagus n = 20; lung n = 20). Risk stratification questionnaires administered in clinic had 100% completion rates. Physiotherapy testing required a trained physiotherapist and an additional visit to the pre-admission clinic; these tests proved difficult to coordinate and had lower completion rates (63–75%). Although most measures were not significantly associated with occurrence of complications, the Modified Frailty Index approached statistical significance (p = 0.06).

Conclusions

Frailty assessment is feasible in the pre-operative outpatient setting and had a high degree of acceptance among surgeons and patients. Of the risk stratification questionnaires, the Modified Frailty Index may be useful in predicting outcomes as per this feasibility study. Pre-operative frailty assessment can identify vulnerable oncology patients to aid in treatment planning with the goal of optimizing clinical outcomes and resource allocation.

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References

  1. Fitzmaurice C (2016) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted l-years for 32 cancer groups, 1990 to 2015. A systematic analysis for the global burden of disease study. JAMA Oncol 3(4):524–548

    Google Scholar 

  2. Andrici J, Eslick GD (2015) Epidemiology and risk factors for esophageal cancer. In: Saba N, El-Rayes B (eds) Esophageal cancer. Springer, Champions. https://doi.org/10.1007/978-3-319-20068-2_1

    Chapter  Google Scholar 

  3. Repana D, Spicer J (2017) Epidemiology of lung cancer. In: Loda M, Mucci L, Mittelstadt ML, Van Hemelrijck M, Cotter MB (eds) Pathology and epidemiology of cancer. Springer, Champions. https://doi.org/10.1007/978-3-319-35153-7_19

    Chapter  Google Scholar 

  4. Hodari A, Hammoud ZT, Borgi JF, Tsiouris A, Rubinfeld IS (2013) Assessment of morbidity and mortality after Esophagectomy using a Modified Frailty Index. Ann Thorac Surg 96(4):1240–1245

    Article  PubMed  Google Scholar 

  5. Talsma A, Damhuis RA, Steyerberg EW et al (2015) Determinants of improved survival after oesophagectomy for cancer. Br J Surg 102(6):668–675

    Article  PubMed  CAS  Google Scholar 

  6. Lin H, Watts J, Peel N et al (2016) Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr 16(157):1–12

    Google Scholar 

  7. Beckert A, Huisingh-Scheetz M, Thompson K et al (2017) Screening for frailty in thoracic surgical patients. Ann Thor Surg 103(3):956–961

    Article  Google Scholar 

  8. Dunne MJ, Abah U, Scarci M (2014) Frailty assessment in thoracic surgery. Interact Cardiovasc Thorac Surg 18(5):667–670

    Article  PubMed  Google Scholar 

  9. Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I (2013) Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res 183(1):104–110

    Article  PubMed  Google Scholar 

  10. Tsiouris A, Hammoud ZT, Velanovich V, Hodari A, Borgi J, Rubinfeld I (2013) A modified frailty index to assess morbidity and mortality after lobectomy. J Surg Res 183(1):40–46

    Article  PubMed  Google Scholar 

  11. Marshall M (1996) Sampling for qualitative research. Fam Pract 13(6):522–525

    Article  PubMed  CAS  Google Scholar 

  12. Velanovich V (2011) A simple frailty index as a predictor of postoperative morbidity and mortality. 97th Clinical Congress of the American College of Surgeons, San Francisco, CA

  13. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KKL, Ludwig LE, Pedan A, Goldman L (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100(10):1043–1049

    Article  PubMed  CAS  Google Scholar 

  14. Charlson M, Pompei P, Ales K et al (1986) A new method for classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383

    Article  Google Scholar 

  15. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579

    Article  PubMed  CAS  Google Scholar 

  16. Darling G, Eton DT, Sulman J, Casson AG, Cella D (2006) Validation of the functional assessment of cancer therapy esophageal cancer subscale. Cancer 107(4):854–863

    Article  PubMed  Google Scholar 

  17. Cella D, Bonomi A, Llyod S et al (1995) Reliability and validity of the functional assessment of cancer therapy – lung (FACT-L) quality of life instrument. Lung Cancer 12:199–200

    Article  PubMed  CAS  Google Scholar 

  18. Casanova C, Celli BR, Barria P, Casas A, Cote C, de Torres JP, Jardim J, Lopez MV, Marin JM, Montes de Oca M, Pinto-Plata V, Aguirre-Jaime A, on behalf of the Six Minute Walk Distance Project (ALAT) (2011) The 6-min walk distance in healthy subjects: reference standards from seven countries. Eur Respir J 37(1):150–156

    Article  PubMed  CAS  Google Scholar 

  19. Enright P (2003) Six-minute walk test. Respir Care 48(8):783–785

    PubMed  Google Scholar 

  20. Afilalo J, Eisenberg MJ, Morin J et al (2010) Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Surg 56(20):1668–1676

    Article  Google Scholar 

  21. Cesari M, Kritchevsky S, Penninx B et al (2005) Prognostic value of usual gait speed in well-functioning older people – results from the health, aging, and body composition study. J Am Geriatr Soc 53(10):1675–1680

    Article  PubMed  Google Scholar 

  22. Klidjian A, Foster K, Kammerling R et al (1980) Relation of anthropometric and dynamometric variables to serious postoperative complications. BMJ 281:899–901

    Article  PubMed  CAS  Google Scholar 

  23. Wong S (2016) Grip Strength Reference Values for Canadians aged 6 to 79: Canadian Health Measures Survey, 2007-2013. Statistics Canada; 19

  24. Sheetz KH, Zhao L, Holcombe SA, Wang SC, Reddy RM, Lin J, Orringer MB, Chang AC (2013) Decreased core muscle size is associated with worse patient survival following esophagectomy for cancer. Dis Esophagus 26(7):716–722

    PubMed  PubMed Central  CAS  Google Scholar 

  25. Cawthon PM, Fox KM, Gandra SR, Delmonico MJ, Chiou CF, Anthony MS, Sewall A, Goodpaster B, Satterfield S, Cummings SR, Harris TB, for the Health, Aging and Body Composition Study (2009) Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? J Am Geriatr Soc 57(8):1411–1419

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jones K, Doleman B, Scott S et al (2014) Simple psoas cross-section area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications. Color Dis 17:20–26

    Article  Google Scholar 

  27. Clavien P, Barkun J, de Oliveira M et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  28. Walston J, McBurnie MA, Newman A (2002) Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the cardiovascular health study. Arch Intern Med 162(20):2333–2341

    Article  PubMed  Google Scholar 

  29. Allen MS, Blackmon S, Nichols FC, Cassivi SD, Shen KR, Wigle DA (2015) Comparison of two national databases for general thoracic surgery. Ann Thorac Surg 100(4):1155–1161

    Article  PubMed  Google Scholar 

  30. Jain R, Gibson L, Coburn N (2018) Prehabilitation for surgical oncology patients: empowering patient volition. Support Cancer Care 26:3665–3667. https://doi.org/10.1007/s00520-018-4300-4

    Article  Google Scholar 

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Acknowledgements

The authors would like to acknowledge Alex Grindley, Frances Allison, and Megan Hudson for their help in data acquisition.

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, 149 College St, Toronto, ON, M5T 1P5, Canada

    Dhruvin H. Hirpara

  2. Section of Thoracic Surgery, Health Sciences Center, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada

    Biniam Kidane

  3. Department of Medical Imaging, Princess Margaret Hospital, 610 University Ave, Toronto, ON, M5G 2M9, Canada

    Patrik Rogalla

  4. Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G1J6, Canada

    Marcelo Cypel, Marc de Perrot, Shaf Keshavjee, Andrew Pierre, Thomas Waddell, Kazuhiro Yasufuku & Gail E. Darling

  5. Toronto General Hospital, 200 Elizabeth St., 9N-955, Toronto, ON, M5G 2C4, Canada

    Gail E. Darling

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  1. Dhruvin H. Hirpara
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  2. Biniam Kidane
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  10. Gail E. Darling
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Correspondence to Gail E. Darling.

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Hirpara, D.H., Kidane, B., Rogalla, P. et al. Frailty assessment prior to thoracic surgery for lung or esophageal cancer: a feasibility study. Support Care Cancer 27, 1535–1540 (2019). https://doi.org/10.1007/s00520-018-4547-9

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  • DOI: https://doi.org/10.1007/s00520-018-4547-9

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