Change in Frailty over Time in Spine Oncology Patients

Introduction: Frailty is a critical predictive measure of outcomes in spine oncology patients. The dynamics of frailty during the disease process is mysterious but essential for optimizing care and improving prognosis. This study aims to evaluate the dynamic nature of frailty in spine oncology patients.

Methods: Frailty was measured in Spine oncology patients at University of Michigan at multiple time points using Metastatic Spinal Tumor Frailty Index (MSTFI) 0=‘no frailty’,1=‘mild frailty’, 2=‘moderate frailty’ ≤ 3=‘severe frailty’. Frailty was assessed at time of initial cancer diagnosis, initial spine metastasis, four, eight, twelve, sixteen, twenty-, and twenty-four-months post diagnosis.

Results: Our study analyzed frailty scores in 390 patients, with Prostate Cancer (21%) and Renal Cell Carcinoma (13.8%) being the most common diagnoses. Frailty scores showed a decline in non-frail patients over time, especially at metastatic diagnosis and four months post-op, though the exclusion of the sickest patients (who died early) may have influenced this. Patients with longer follow-up (up to two years) experienced slower progression to severe frailty, indicating better health compared to those with shorter follow-up. More patients transitioned from non-frail or moderately frail to severely frail, with worsening frailty being more common than recovery. Overall, frailty increased significantly over time (coefficient 0.032, p-value 0.02), and lower frailty scores correlated with better survival. Frailty group 0 was significantly different from all others (p-values < 0.005), with group 1 also distinct from group 3 (p-value 0.02).

Conclusion : This data shows that frailty is dynamic process and that there may be an intervention point early in the disease process. Further investigations need to be performed to assess which variables in the frailty scale are most dynamic.