Frailty transitions and associated factors in older cancer survivors in the USA: using a multi-state modeling.

PURPOSE

Frailty is a major concern in the aging cancer population. It can progress to severe frailty or death or improve to pre-frail or non-frail states. However, frailty transitions in older cancer survivors are not well understood. This study aimed to explore frailty transitions and associated factors in older cancer survivors.

METHODS

We analyzed data from the National Health and Aging Trends Study (NHATS) in 2017-2022, focusing on older adults aged ≥ 65 who have been diagnosed with cancer. Frailty was assessed annually using the Fried Frailty Phenotype. Multi-state Markov models were used to explore transitions between frailty states (non-frail, pre-frail, frail, and death) and examine the association with sociodemographic factors, comorbidities, and inflammatory biomarkers (IL-6 and CRP).

RESULTS

Among 1219 survivors, 25.27% were non-frail, 52.34% pre-frail, and 22.40% frail at baseline. Over 5 years, there were 1396 transitions: 950 (68.05%) progressed or deceased, and 446 (31.95%) reversed. Pre-frail individuals transitioned to frailty slightly more than they reversed to non-frailty (0.25 vs. 0.21). Frail individuals were more likely to decease than to reverse (0.30 vs. 0.28). Factors associated with frailty progression included older age, lower education, more comorbidities, and higher IL-6 and CRP levels. Being female and obese were protective against the frailty-to-death transition.

CONCLUSIONS

The results showed dynamic frailty transitions in older cancer survivors and identified key sociodemographic and physiological factors.

IMPLICATIONS FOR CANCER SURVIVORS

These findings can guide targeted interventions, highlighting the importance of early identification and tailored approaches to prevent frailty progression in older cancer survivors.