Exploration of frailty trajectories and their associations with health outcomes in older gastric cancer survivors undergoing radical gastrectomy: A prospective longitudinal observation study

Background: Frailty is commom among gastric cancer survivors and increases the burden of care. Aims: Our aims were to identify the frailty trajectories and investigate their associations with health outcomes in older gastric cancer survivors. Methods: We finally recruited 381 patients aged >= 60 who underwent radical gastrectomy and recorded frailty at discharge from the hospital, 1, 3, 6, and 12 months after surgery. Growth mixture modeling was used to investigate the frailty trajectories and linear regression models were used to examine their associations with health outcomes. Results: Three classes of frailty trajectories were identified: the "improving frailty", "maintaining frailty" and "deteriorating frailty". Compared with class 1, patients who followed class 2 and class 3 frailty trajectories were more likely to have more severe disability (13 =-14.22, 95 % CI:-17.92,-10.61, P < 0.001; 13 =-48.34, 95 % CI:-52.25,-44.42, P < 0.001), worse quality of life (13 =10.89, 95 % CI: 7.71,14.08, P < 0.001; 13 = 34.82, 95 % CI: 31.46, 38.19, P < 0.001), and more frequency readmission within 1 year (13 = 1.02, 95 % CI: 0.98, 1.06, P < 0.001; 13 = 2.10, 95 % CI: 2.01, 2.14, P < 0.001) after controlling potential confounders. However, class 2 and class 3 have no significant difference from class 1 in the total hospitalization costs (13 = 1672.12, 95 % CI:-7145.95, 10496.19, P = 0.709; 13 = 7651.60, 95 % CI:-1670.28, 16793.47, P = 0.107). Conclusions: Our study suggested the significant prognostic heterogeneity in frailty trajectories, and what we need to do is to identify patients with heterogeneous trajectory and intervene in them to reduce adverse outcomes, promote rational use of resources, and reduce the burden of care.