Preoperative frailty screening in elderly patients with non-small cell lung cancer surgery: an essential step for a good surgical outcome

ABSTRACT

Introduction

Non-small cell lung cancer (NSCLC) is a disease commonly diagnosed in the elderly, often in advanced stages. However, elderly patients with lung cancer can benefit from surgery, provided that postoperative risks are assessed appropriately before surgery. Frailty is a measure of age-related impaired functional status and a predictor of mortality and morbidity. However, its importance as a preoperative marker is not well defined.

Areas covered

This systematic review discusses the importance of preoperative frailty screening in elderly patients with NSCLC. A literature search was performed on the MEDLINE database in June 2023, and relevant studies on frailty or preoperative assessment of NSCLC which were published between 2000 and 2023 were retained and discussed in this review.

Expert opinion

Among the types of existing methods used to assess frailty those on the geriatric assessment seem to be the most appropriate; however, they are unable to fully capture the ‘surgical’ frailty; thus, other instruments should be developed and validated in NSCLC.

KEYWORDS:

• Elderly
• frailty
• non-small cell lung cancer
• palliative care
• thoracic surgery
• vulnerability

Article highlights

• NSCLC is prevalent in the elderly, and despite intensive screening programs, it is diagnosed at more advanced stages in this age category.

• Frailty includes several age-related deficits and is considered a relevant measure of impaired functional status in the elderly population.

• Frailty can be measured with objective measures, self-reported instruments, or as a part of the geriatric assessment; however, only geriatric measurements can capture the most relevant determinants of frailty.

• In NSCLC, preoperative frailty is associated with an increased risk of postoperative complications and early postoperative death.

• There is a need for better frailty instruments that can be used in the particular setting of geriatric cancer surgery, which should include items currently evaluated by conventional and generic preoperative approaches, as well as others such as social frailty.

Declarations of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the University of Medicine and Pharmacy Iasi Romania: Internal grant 9990/2022 Radu Iacobescu is funded with PhD grant 2302/2022.