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

Magnus Harneshaug; Lene Kirkhus; Jūratė Šaltytė Benth; Bjørn Henning Grønberg; Sverre Bergh; Jon Elling Whist; Siri Rostoft; Marit S Jordhøy

doi:10.1016/j.jgo.2018.07.003

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

J Geriatr Oncol. 2019 Mar;10(2):272-278. doi: 10.1016/j.jgo.2018.07.003. Epub 2018 Jul 23.

Authors

Magnus Harneshaug¹, Lene Kirkhus², Jūratė Šaltytė Benth³, Bjørn Henning Grønberg⁴, Sverre Bergh⁵, Jon Elling Whist⁶, Siri Rostoft⁷, Marit S Jordhøy⁸

Affiliations

¹ The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 4956, Nydalen, 0424 Oslo, Norway. Electronic address: Magnus.Harneshaug@sykehuset-innlandet.no.
² The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2313 Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 4956, Nydalen, 0424 Oslo, Norway. Electronic address: Lene.Kirkhus@sykehuset-innlandet.no.
³ The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2313 Ottestad, Norway; HØKH Research Centre, Akershus University Hospital, P.O. Box 1000, 1478 Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, P.O. Box 1171, 0318 Blinderen, Norway. Electronic address: jurate.saltyte-benth@medisin.uio.no.
⁴ The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, P.O. Box 3250, Sluppen, 7006 Trondheim, Norway; Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway.
⁵ The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, P.O. Box 68, 2313 Ottestad, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway. Electronic address: Sverre.Bergh@sykehuset-innlandet.no.
⁶ The Department of Research, Innlandet Hospital Trust, P.O. Box 104, 2381 Brumunddal, Norway; Laboratory of Medical Biochemistry, Innlandet Hospital Trust, P.O. 2381, Brumunddal, Norway. Electronic address: Jon.Elling.Whist@sykehuset-innlandet.no.
⁷ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 4956, Nydalen, 0424 Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway.
⁸ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 4956, Nydalen, 0424 Oslo, Norway; The Cancer Unit, Innlandet Hospital Trust, Hamar Hospital, Skolegata 32, 2326 Hamar, Norway.

PMID: 30049582
DOI: 10.1016/j.jgo.2018.07.003

Abstract

Introduction: 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 is scored from 0 to 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 patients with cancer.

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), and blood samples were collected.

Results: Mean age was 76.7 years, 49.8% were frail, and 56.1% had distant metastases. The proportion of frail patients increased with higher GPS (GPS zero: 43.2%, GPS one: 52.7%, GPS two: 94.7%). GPS two was 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 was low (14%). Frail patients with GPS two had 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 GPS two are strongly associated, and GPS two is a significant prognostic factor in frail, older patients with cancer. The inflammatory biomarkers investigated are not suitable screening tools for frailty.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Accidental Falls
Activities of Daily Living
Aged
C-Reactive Protein / metabolism*
Comorbidity
Depression
Female
Frailty / diagnosis*
Frailty / epidemiology
Frailty / metabolism
Geriatric Assessment
Humans
Inflammation / metabolism*
Interleukin-6 / metabolism*
Male
Mass Screening
Mental Status and Dementia Tests
Neoplasms / epidemiology
Neoplasms / therapy*
Nutritional Status
Physical Functional Performance
Polypharmacy
Prognosis
Prospective Studies
Serum Albumin / metabolism*
Tumor Necrosis Factor-alpha / metabolism*

Substances

IL6 protein, human
Interleukin-6
Serum Albumin
TNF protein, human
Tumor Necrosis Factor-alpha
C-Reactive Protein