Prognostic value of the veterans affairs frailty index in older patients with non‐small cell lung cancer

• Published in: Cancer medicine (Malden, MA) Vol. 11; no. 15; pp. 3009 - 3022
• Main Authors: Cheng, David, Dumontier, Clark, Sheikh, Ayesha R., La, Jennifer, Brophy, Mary T., Do, Nhan V., Driver, Jane A., Tuck, David P., Fillmore, Nathanael R.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-08-2022; John Wiley and Sons Inc; Wiley
• Subjects: Aged; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - epidemiology; Cardiovascular disease; Codes; Comorbidity; Diagnosis; Electronic health records; Electronic medical records; Emergency medical care; Frailty; Frailty - diagnosis; Frailty - epidemiology; Geriatrics; Health care policy; Hospitalization; Humans; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - epidemiology; Medicaid; Medicare; Mortality; Non-small cell lung carcinoma; non‐small cell lung; Oncology; Patients; Population; Prognosis; R&D; Research & development; Small cell lung carcinoma; Statistical analysis; United States - epidemiology; Veterans; United States; frailty; veterans; electronic health records; prognosis; non-small cell lung
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.4658

Background
Older patients with non‐small cell lung cancer (NSCLC) are a heterogeneous population with varying degrees of frailty. An electronic frailty index such as the Veterans Affairs Frailty Index (VA‐FI) can potentially help identify vulnerable patients at high risk of poor outcomes.
Methods
NSCLC patients ≥65 years old and diagnosed in 2002–2017 were identified using the VA Central Cancer Registry. The VA‐FI was calculated using administrative codes from VA electronic health records data linked with Medicare and Medicaid data. We assessed associations between the VA‐FI and times to mortality, hospitalization, and emergency room (ER) visit following diagnosis by Kaplan–Meier analysis and multivariable stratified Cox models. We also evaluated the change in discrimination and calibration of reference prognostic models after adding VA‐FI.
Results
We identified a cohort of 42,204 older NSCLC VA patients, in which 55.5% were classified as frail (VA‐FI >0.2). After adjustment, there was a strong association between VA‐FI and the risk of mortality (HR = 1.23 for an increase of four deficits or, equivalently, an increase of 0.129 on VA‐FI, p < 0.001), hospitalization (HR = 1.16 for four deficits, p < 0.001), and ER visit (HR = 1.18 for four deficits, p < 0.001). Adding VA‐FI to baseline prognostic models led to statistically significant improvements in time‐dependent area under curves and did not have a strong impact on calibration.
Conclusion
Older NSCLC patients with higher VA‐FI have significantly elevated risks of mortality, hospitalizations, and ER visits following diagnosis. An electronic frailty index can serve as an accessible tool to identify patients with vulnerabilities to inform clinical care and research.
Older non‐small cell lung cancer patients with higher values of an electronic frailty index have elevated risks of mortality and acute care utilization following diagnosis. Such an electronic index can help identify vulnerable patients to inform clinical decision‐making and research.