The Relationship Between Frailty and Emotional Health in Older Patients with Advanced Cancer

Nikesha Gilmore, Lee Kehoe, Jessica Bauer, Huiwen Xu, Bianca Hall, Megan Wells, Lianlian Lei, Eva Culakova, Marie Flannery, Valerie Aarne Grossman, Ronak Amir Sardari, Himal Subramanya, Sindhuja Kadambi, Elizabeth Belcher, Jared Kettinger, Mark A. O'Rourke, Elie G. Dib, Nicholas J. Vogelzang, William Dale, Supriya Mohile

Research output: Contribution to journalArticlepeer-review


Background: Aging-related deficits that eventually manifest as frailty may be associated with poor emotional health in older patients with advanced cancer. This study aimed to examine the relationship between frailty and emotional health in this population. Methods: This was a secondary analysis of baseline data from a nationwide cluster randomized trial. Patients were aged ≥70 years with incurable stage III/IV solid tumors or lymphomas, had ≥1 geriatric assessment (GA) domain impairment, and had completed the Geriatric Depression Scale, Generalized Anxiety Disorder-7, and Distress Thermometer. Frailty was assessed using a Deficit Accumulation Index (DAI; range 0–1) based on GA, which did not include emotional health variables (depression and anxiety), and participants were stratified into robust, prefrail, and frail categories. Multivariate logistic regression models examined the association of frailty with emotional health outcomes. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. Results: Five hundred forty-one patients were included (mean age: 77 years; 70–96). DAI ranged from 0.04 to 0.94; 27% of patients were classified as robust, 42% prefrail, and 31% frail. Compared with robust patients, frail patients had an increased risk of screening positive for depression (aOR = 12.8; 95% CI = 6.1–27.0), anxiety (aOR = 6.6; 95% CI = 2.2–19.7), and emotional distress (aOR = 4.62; 95% CI = 2.9–8.3). Prefrail compared with robust patients also had an increased risk of screening positive for depression (aOR = 2.22; 95% CI = 1.0–4.8) and distress (aOR = 1.71; 95% CI = 1.0–2.8). Conclusion: In older patients with advanced cancer, frailty is associated with poorer emotional health, which indicates a need for an integrated care approach to treating these patients. Implications for Practice: A relationship exists between frailty and poor emotional health in older adults with advanced cancer. Identifying areas of frailty can prompt screening for emotional health and guide delivery of appropriate interventions. Alternatively, attention to emotional health may also improve frailty.

Original languageEnglish (US)
Pages (from-to)e2181-e2191
Issue number12
StatePublished - Dec 2021
Externally publishedYes


  • Anxiety
  • Depression
  • Distress
  • Emotional health
  • Frailty
  • Geriatric assessment

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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