Screening for frailty among older patients with cancer using blood biomarkers of inflammation

Abstract

As frailty is associated with inflammation, biomarkers of inflammation may represent objective measures that could facilitate the identification of frailty. Glasgow prognostic score (GPS), combines C-reactive protein (CRP) and albumin, and isscored from 0-2 points. Higher score indicates a higher degree of inflammation.Objectives: To investigate whether (1)GPS is associated with frailty,(2)GPS could be used to screen for frailty, (3) IL-6 and TNF-α add to the accuracy of GPS as a screening tool, and(4)GPS adds prognostic information in frail older cancer patients.Methods:Prospective, observational study of 255 patients ≥ 70 years with solid malignant tumours referred for medical cancer treatment.At baseline, frail patients were identified by a modified Geriatric Assessment (mGA), andblood samples were collected. Results: Mean age was 76.7years, 49.8% were frail, and 56.1% had distant metastases. The proportion of frail patients increased with higher GPS (GPSzero: 43.2%, GPSone:52.7%, GPStwo: 94.7%). GPStwowas significantly associated with frailty (OR 18.5), independent of cancer type, stage, BMI and the use of anti-inflammatory drugs. The specificity of GPS was high (99%), but the sensitivity waslow (14%). Frail patients with GPStwohad poorer survival than patients with GPS zero-one. TNF-α and IL-6 did not improve the accuracy of GPS when screening for frailty.Conclusion: Frailty and GPStwoarestrongly associated,and GPStwois a significant prognostic factor in frail, older cancer patients. The inflammatory biomarkers investigated are not suitable screening tools for frailty.