Change in Frailty Over Time in Spine Oncology Patients

Introduction: Frailty is a critical predictive measure of outcomes in spine oncology patients. The dynamics of frailty during the disease process is unknown. Understanding how frailty changes throughout the disease process can give insights into new treatment paradigms that may make frailty not only a predictive value but something that is amenable to intervention. The purpose of this study is to evaluate the dynamic nature of frailty in spine oncology patients.

Methods: Frailty was measured in Spine oncology patients at University of Michigan at multiple time points using Metastatic Spinal Tumor Frailty Index (MSTFI) 0=‘no frailty’,1=‘mild frailty’, 2=‘moderate frailty’ ≤ 3=‘severe frailty’. Frailty was assessed at time of initial cancer diagnosis, initial spine metastasis, four, eight, twelve, sixteen, twenty-, and twenty-four-months post diagnosis.

Results: Our study analyzed frailty scores in 390 patients. Frailty scores showed a decline in non-frail patients over time, especially at metastatic diagnosis and four months after. More patients transitioned from non-frail or moderately frail to severely frail, with worsening frailty being more common than recovery. Overall, frailty increased significantly over time (coefficient 0.032, p-value 0.02), and lower frailty scores correlated with better survival. Frailty group 0 was significantly different from all others (p-values < 0.005), with group 1 also distinct from group 3 (p-value 0.02). When examining which variables contributed most to patient frailty: anemia, electrolytes and malnutrition had the greatest effect on frailty score.

Conclusion : This data shows that frailty is a dynamic process that changes over the disease course with worsening frailty leading to a significant decrease time of survival. There may be an intervention point early in the disease process with the greatest effect on frailty coming from variables that could be intervened upon (anemia, nutrition). This data sets the stage for studies investigating early nutritional intervention to examine how malleable these variables are in this patient population.