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Answering the call: Are we ready for action on frailty in gynecologic oncology?

  • Amanika Kumar
    Correspondence
    Corresponding author at: 200 First Street, Rochester, MN 55905, United States of America.
    Affiliations
    Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America
    Search for articles by this author
      Frailty is an age-related clinical diagnosis characterized by an increased vulnerability to stressors and a lack of resilience. Frailty can predict a patient's inability to “bounce-back” from the stress of cancer itself and the stress of treatment related toxicity [
      • Morley J.E.
      • Vellas B.
      • van Kan G.A.
      • Anker S.D.
      • Bauer J.M.
      • Bernabei R.
      • et al.
      Frailty consensus: a call to action.
      ]. This has traditionally relied on physician gestalt, using co-morbidities, functional and social status, and overall well-being, to help guide treatment to match the patient. We have all faced a patient in the clinic and thought to ourselves, “while this patient's disease is resectable, I don't think she will tolerate the surgery she requires, lets do chemotherapy instead.” The field of aging and frailty research have applied objective measurements to what used to be left to subjective clinical judgement. The fields of oncology and gynecologic oncology have embraced frailty as an area of important clinical practice and research investigation with more articles published yearly addressing the prevalence and impact of frailty in the gynecologic oncology population. While there has been a wealth of retrospective database studies that clearly point to the importance of frailty in gynecologic cancer care [
      • Kumar A.
      • Langstraat C.L.
      • DeJong S.R.
      • McGree M.E.
      • Bakkum-Gamez J.N.
      • Weaver A.L.
      • et al.
      Functional not chronologic age: frailty index predicts outcomes in advanced ovarian cancer.
      ,
      • Donato V.
      • Caruso G.
      • Bogani G.
      • et al.
      Preoperative frailty assessment in patients undergoing gynecologic oncology surgery: a systematic review.
      ,
      • George E.
      • Burke W.
      • Hou J.
      • Tergas A.
      • Chen L.
      • Neugut A.
      • Ananth C.
      • Hershman D.
      • J.
      Wright measurement and validation of frailty as a predictor of outcomes in women undergoing major gynaecological surgery BJOG.
      ,
      • Uppal S.
      • Igwe E.
      • Rice L.W.
      • Spencer R.J.
      • S.L.
      Rose Frailty index predicts severe complications in gynecologic oncology patients.
      ], there remains critical questions about how to evaluate frailty, who to evaluate, and how to impact frailty to effect meaningful outcomes.
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