Pre-frailty and frailty as predictors of mortality in colorectal cancer survivors: a nationally representative study using NHIS 1997–2018
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Background Frailty is a multidimensional syndrome associated with increased vulnerability to adverse health outcomes, particularly among older adults. Its relevance in cancer survivorship is increasingly recognized, yet the prognostic implications of frailty and pre-frailty among colorectal cancer survivors remain poorly defined. Methods We analyzed data from the 1997–2018 National Health Interview Survey (NHIS), linked to mortality outcomes through December 31, 2019, via the National Death Index. Frailty status was determined using a modified FRAIL scale and categorized as robust (score = 0), pre-frail (score = 1–2), or frail (score = 3–5). Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality by frailty status, adjusting for demographic, socioeconomic, and clinical variables. Subgroup analyses were conducted by age and sex. Results Among 4,052 colorectal cancer survivors, 70.2% were robust, 12.4% pre-frail, and 17.4% frail. Frailty and pre-frailty were more prevalent among survivors than among cancer-free participants (6.5% frail; 5.0% pre-frail). In fully adjusted models, pre-frail and frail survivors had significantly higher risks of all-cause mortality compared to robust individuals (HR for pre-frail, 1.44; 95% CI, 1.21–1.71; P < 0.001; HR for frail, 2.19; 95% CI, 1.89–2.56; P < 0.001). These associations persisted across age and sex subgroups, although they were attenuated in younger adults and in men for pre-frailty. Kaplan–Meier curves demonstrated significantly reduced survival across increasing frailty categories. Conclusions Frailty and pre-frailty are common among colorectal cancer survivors and are independently associated with increased risk of all-cause mortality. Routine frailty assessment using simple screening tools may aid in identifying vulnerable individuals and informing survivorship care strategies aimed at improving long-term outcomes.
