Frailty Much More Likely in Older Black Patients With GI Cancer

Older Black adults with newly diagnosed gastrointestinal (GI) malignancies have higher rates of frailty and functional impairments than White patients, according to new findings.

Overall, half of Black patients and nearly one third of White patients were frail. Black participants were also significantly more likely to report limitations in walking one block and performing basic activities of daily living as well as moderate or severe pain.

"As frailty and functional impairments are associated with increased chemotherapy toxicities, hospitalizations, and poorer overall survival, these differences may in part explain racial disparities in cancer outcomes," lead author Grant R. Williams, MD, MSPH, assistant professor in the division of hematology and oncology and director of the cancer and aging program at The University of Alabama at Birmingham, said in a statement.

The study was published online this month in journal Cancer.

Racial disparities have long been reported in cancer care, despite advances in treatment. Recent data revealed Black patients have a higher risk of mortality from GI cancers compared with White patients, in part because of disparities in access to surgical care.

But, as Williams and colleagues point out, the causes of disparities in cancer outcomes are likely multifactorial and reflect an interplay of numerous factors, including greater stress and reduced confidence in medical care.

In this study, Williams and colleagues sought to assess how frailty may contribute to GI cancer disparities.

The authors evaluated racial differences in frailty and geriatric impairments among an unselected cohort of 553 older adults who had recently been diagnosed with a GI cancer — 23% were Black and the remainder non-Hispanic White. Patients were from the Cancer and Aging Resilience Evaluation Registry, a prospective cohort study that enrolled older adults with GI malignancies presenting for their initial consultation.

Patients' primary cancer diagnoses included colorectal cancer (32%), followed by pancreatic (27%) and hepatobiliary cancers (18%). The mean age of the cohort was 70 years, but Black patients were slightly younger (68.7 years) and had lower levels of educational attainment and higher levels of disabled employment status. There were no significant differences in the stage of disease between the two racial groups.

All participants had a geriatric assessment completed before chemotherapy initiation and self-reported as either White or Black. Frailty was defined using a 44-item frailty index.

The authors found that Black patients were 2.6 times more likely to be frail than White participants (adjusted odds ratio, 2.59; P < .001). Black patients were also more likely to experience limitations in daily living activities (27.3% vs 14.1%; P = .001), instrumental activities of daily living, such as housecleaning and shopping (64.8% vs 47.3%; P = .002), walking 1 block (62.5% vs 48.2%; P = .004), and moderate or severe pain (54.7% vs 40%; P = .005). These differences persisted even after adjusting for confounders including age, sex, education, cancer type, and comorbidities.

"This study takes one of the first steps toward understanding frailty and geriatric assessment impairments in dually vulnerable older Black adults with cancer," the authors conclude. "The increased prevalence of frailty in older Black participants may at least partially mediate known differences in cancer outcomes and warrant further investigation."

In an accompanying editorial, Jana Wieland, MD, Barbara Jordan, MA, and Aminah Jatoi, MD, all from the Mayo Clinic in Rochester, Minnesota, say the findings highlight the value of incorporating geriatric assessment-driven interventions into clinical practice for older, frail patients.

These "important observations" provide "actionable opportunities to improve the lives of older patients with cancer, most notably those patients of diverse

backgrounds, including those who are Black, live in the Deep South, and have been diagnosed with a gastrointestinal malignancy" and can "bring us closer to equity in cancer care," the authors write.

Williams disclosed consulting fees from Carevive Systems and Cardinal Health. Other co-authors also reported disclosures; the full list can be found with the original article. The editorialists have disclosed no relevant financial relationships.

Cancer. Published online April 11, 2022. Full text, Editorial

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