# High burden of geriatric assessment impairments across the adult age spectrum in patients with cancer

## TL;DR

Frailty and geriatric impairments are common in cancer patients of all ages, with distinct patterns emerging as patients grow older.

## Contribution

This study quantifies geriatric assessment impairments across adult age groups with cancer and identifies age-specific patterns and their prognostic relevance.

## Key findings

- Frailty prevalence increases with age, with 74.4% of patients aged ≥80 classified as frail.
- Malnutrition is the most frequent geriatric deficit across all age groups.
- Frailty and prefrailty are associated with worse overall survival in cancer patients.

## Abstract

The age-specific distribution of frailty and its domain-level characteristics remain poorly understood across the adult population of patients with cancer. We aimed to quantify the frailty prevalence and geriatric assessment (GA) impairment patterns in adults and to examine their prognostic relevance in newly diagnosed patients with cancer.

This multicenter, cross-sectional cohort enrolled 2,501 adults (≥20 years) before therapy in 2021-2023. GA covered 8 domains (function, comorbidity, cognition, mood, nutrition, polypharmacy, falls, and social support). Patients were grouped into 6 age bands (20-39 to ≥80) and labeled fit (0 deficits), prefrail (1), or frail (≥2). We analyzed age-specific geriatric impairment patterns and overall survival (OS).

The mean number of GA deficits increased significantly across the 6 ordered age bands. Frailty was common and increased with age: 40.0% (20-39), 42.3% (40-49), 56.2% (70-79), and 74.4% (≥80). Malnutrition was the most frequent deficit (59.1% overall), affecting 51% of patients aged 20-39 years, peaking at 63.8% in the 70-79-year cohort. Older age groups showed steeper increases in comorbidities, cognitive impairment, and functional decline. Polypharmacy and depressed mood were frequent, but varied less with age; inadequate social support was uniformly low. In multivariable models, prefrailty and frailty predicted worse OS. Age-stratified analyses of 40-49, 50-59, and 70-79-year cohorts showed similar associations.

Frailty is prevalent across adults of all ages with distinct, age-associated GA profiles. Nutritional deficits were the most prevalent impairment even among younger adults, whereas functional, comorbidity, and cognitive burdens escalate in older patients with cancer. Routine pretreatment GA for all adults can identify vulnerabilities and enable age-tailored supportive interventions.

Graphical Abstract