Evidence map›Paper›PMID 39657913›Full record

ArticleThe oncologist2025

Associations of frailty with survival, hospitalization, functional decline, and toxicity among older adults with advanced non-small cell lung cancer.

Howard J Lee, John Boscardin, Louise C Walter, Alexander K Smith, Harvey J Cohen, Smith Giri, Grant R Williams, Carolyn J Presley, Surbhi Singhal, Li-Wen Huang and 14 more

Abstract read
In one paragraph

Article in The oncologist, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Howard J LeeDivision of Hematology/Oncology, University of California, San Francisco, San Francisco, CA 94143, United States.
John BoscardinDivision of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, CA 94143, United States.
Louise C WalterDivision of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, CA 94143, United States.
Alexander K SmithDivision of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, CA 94143, United States.
Harvey J CohenCenter for the Study of Aging & Human Development and Duke Cancer Institute, Duke University, Durham, NC 27708, United States.
Smith GiriDivisions of Hematology/Oncology and Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, AL 35294, United States.
Grant R WilliamsDivisions of Hematology/Oncology and Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, AL 35294, United States.
Carolyn J PresleyDivision of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, United States.
Surbhi SinghalDivision of Hematology and Oncology, University of California, Davis, Sacramento, CA 95819, United States.
Li-Wen HuangDivision of Hematology/Oncology, University of California, San Francisco, San Francisco, CA 94143, United States.
Ana I VelazquezDivision of Hematology/Oncology, University of California, San Francisco, San Francisco, CA 94143, United States.
Matthew A GubensDivision of Hematology/Oncology, University of California, San Francisco, San Francisco, CA 94143, United States.
Collin M BlakelyDivision of Hematology/Oncology, University of California, San Francisco, San Francisco, CA 94143, United States.
Claire K MulveyDivision of Hematology/Oncology, University of California, San Francisco, San Francisco, CA 94143, United States.
Michael L ChengDivision of Hematology/Oncology, University of California, San Francisco, San Francisco, CA 94143, United States.
Lori C SakodaDivision of Research, Kaiser Permanente Northern California, The Permanente Medical Group, Pleasanton, CA 94588, United States.
Lawrence H KushiDivision of Research, Kaiser Permanente Northern California, The Permanente Medical Group, Pleasanton, CA 94588, United States.
Charles QuesenberryDivision of Research, Kaiser Permanente Northern California, The Permanente Medical Group, Pleasanton, CA 94588, United States.
Raymond LiuDivision of Research, Kaiser Permanente Northern California, The Permanente Medical Group, Pleasanton, CA 94588, United States.
Sara Fleszar-PavlovicSylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, United States.
Caroline EskandarDivision of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, CA 94143, United States.
Edward CutlerLens Study Patient and Caregiver Advisory Board, Pleasanton, CA 94588, United States.
Anne Marie MercurioLens Study Patient and Caregiver Advisory Board, Pleasanton, CA 94588, United States.
Melisa L WongDivision of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, CA 94143, United States.

Funding

Translational InformaticsP30CA082103 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Alan Ashworth · 1999 to 2026
$209.7M
Translational Therapeutics Research Program (TT)P30CA016058 · NCI · OHIO STATE UNIVERSITY · PI Daniel G. Stover · 1985 to 2026
$132.3M
Resource Core 3 - Metabolomics CoreP30AG028716 · NIA · DUKE UNIVERSITY · PI CATHLEEN S COLON-EMERIC, Susan Nicole Hastings · 2006 to 2026
$24.6M
VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Louise C. Walter · 2013 to 2026
$19.9M
Institutional Career Development Core SupplementKL2TR001870 · NCATS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KANAYA, ALKA M., SARKAR, URMIMALA · 2016 to 2025
$19.7M
RESOURCE CENTER FOR AGING RESEARCH IN DIVERSE POPULATIONP30AG015272 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Torsten Brian Neilands · 1997 to 2026
$19.5M
RESEARCH TRAINING IN GERIATRIC MEDICINET32AG000212 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Alexander Keliimoeanu Smith · 1991 to 2026
$7.7M
Training to Reduce Burden across the Cancer Control Continuum (TRACC)T32CA251064 · NCI · UNIVERSITY OF MIAMI CORAL GABLES · PI ERIN N KOBETZ, Frank J Penedo · 2020 to 2026
$3.2M
Advancing patient-centered decision making in older adults with lung cancer: Incorporating risk of functional decline into treatment discussionsK76AG064431 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI WONG, MELISA L · 2019 to 2023
$1.3M
Resiliency among Older Adults Receiving Lung Cancer Treatment: A Supportive Care Intervention StudyK76AG074923 · NIA · OHIO STATE UNIVERSITY · PI PRESLEY, CAROLYN · 2021 to 2025
$1.2M
Mentoring Researchers in Prognosis Research in Alzheimer’s Disease and Related DementiasK24AG068312 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Alexander Keliimoeanu Smith · 2020 to 2026
$1.2M
Myopenia and Mechanisms of Chemotherapy Toxicity in Older Adults with Colorectal Cancer: The M&M StudyK08CA234225 · NCI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI WILLIAMS, GRANT R · 2018 to 2022
$1.0M
NCATS NIH HHS KL2 TR001870NCI NIH HHS K08 CA234225NCI NIH HHS P30 CA016058NCI NIH HHS P30 CA082103NCI NIH HHS T32 CA251064NIA NIH HHS K24 AG068312NIA NIH HHS K76 AG064431NIA NIH HHS K76 AG074923NIA NIH HHS P30 AG015272NIA NIH HHS P30 AG028716NIA NIH HHS P30 AG044281NIA NIH HHS R03 AG056439NIA NIH HHS R03 AG064374NIA NIH HHS R03 AG067935NIA NIH HHS T32 AG000212NIH HHS K08CA234225NIH HHS K24AG068312NIH HHS K76AG064431NIH HHS KL2TR001870NIH HHS P30AG015272NIH HHS P30AG028716NIH HHS P30AG044281NIH HHS P30CA016058NIH HHS P30CA082103NIH HHS R03AG056439NIH HHS R03AG064374NIH HHS R03AG067935NIH HHS T32AG000212NIH HHS T32CA251064San Francisco Helen Diller Family Comprehensive Cancer CenterThe Permanente Medical Group and University of California
6 · The paper itself

Abstract

introductionAmong older adults with cancer receiving chemotherapy, frailty indices predict OS and toxicity. Given the increased use of immunotherapy and targeted therapy for advanced non-small cell lung cancer (aNSCLC), we evaluated frailty and Karnofsky Performance Status (KPS) among older adults with aNSCLC receiving chemotherapy, immunotherapy, and/or targeted therapy.

methodsPatients aged ≥ 65 with aNSCLC starting systemic therapy with non-curative intent underwent geriatric assessments over 6 months. We developed a deficit-accumulation frailty index to categorize patients as robust, pre-frail, or frail. To evaluate associations between frailty and KPS with OS, we used Cox proportional hazards models adjusted for race, insurance, and treatment. We used logistic regression to evaluate hospitalizations, functional decline, and severe toxicity.

resultsAmong 155 patients (median age 73), 45.8% were robust, 36.1% pre-frail, and 18.2% frail; 34.8% had a KPS ≥ 90, 32.9% had a KPS of 80, and 32.3% had a KPS ≤ 70. The median OS was 17.9 months. Pre-frail/frail patients had worse OS compared to robust patients (adjusted hazard ratio [HR] 2.09, 95% CI, 1.31-3.34) and were more likely to be hospitalized (adjusted odds ratio [OR] 2.21, 95% CI, 1.09-4.48), functionally decline (adjusted OR 2.29, 95% CI, 1.09-4.78), and experience grade ≥ 3 hematologic toxicity (adjusted OR 5.18, 95% CI, 1.02-26.03). KPS was only associated with OS.

conclusionsOur frailty index was associated with OS, hospitalization, functional decline, and hematologic AEs among older adults with aNSCLC receiving systemic therapies, while KPS was only associated with OS. Pretreatment frailty assessment may help identify older adults at risk for poor outcomes to optimize decision-making and supportive care.

Indexed as

Carcinoma, Non-Small-Cell LungFrailtyLung NeoplasmsAgedAged, 80 and overFemaleFrail ElderlyGeriatric AssessmentHospitalizationHumansKarnofsky Performance StatusMalefrailty indexgeriatric assessmentlung cancerolderperformance status

Identifiers

PMID39657913
PMCPMC12395243

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.