Association between frailty and chemotherapy toxicity in patients with gastrointestinal tumors: A prospective observational study

Background Pre-chemotherapy frailty has a high prevalence rate among patients with gastrointestinal tumors, and frailty is associated with potential adverse chemotherapy outcomes. However, longitudinal studies on the impact of frailty on long-term chemotherapy toxicity are insufficient. Further research into the relationship between frailty and chemotherapy toxicity in patients with gastrointestinal tumors, as well as the identification of frailty's influencing factors, remains crucial for optimizing pre-chemotherapy patient care assessment. Methods From February 2023 to January 2024, convenience sampling was employed to select patients with gastrointestinal tumors meeting inclusion criteria from a tertiary general hospital in Shandong Province, China. These patients were enrolled in the study. Demographic, disease-related, frailty, social support, depression, and nutritional risk characteristics of the patients were assessed using questionnaires Within 48 hours before the initiation of the first chemotherapy after admission to the hospital. Chemotherapy toxicity was monitored using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 at the first chemotherapy cycle (T1), the third month (T2), and the sixth month (T3). Binary logistic regression was used to analyze the influencing factors of frailty, while the generalized estimating equation (GEE) was used to evaluate the impact of pre-chemotherapy frailty on chemotherapy toxicity in patients with gastrointestinal tumors at different time points. Results A total of 248 questionnaires were distributed, and 238, 220 and 193 patients completed the follow-up at T1, T2 and T3, respectively. The incidence of frailty was 34.03%. Age, education level, comorbidities, depression score, and nutritional risk score were identified as significant predictors of frailty in patients with gastrointestinal tumors before chemotherapy (P < 0.05). A high prevalence of chemotherapy toxicity was observed, with 97.08% of patients experiencing some degree of toxicity. After controlling for potential confounders, a statistically significant difference in chemotherapy toxicity was identified between the frailty and non-frailty group (P < 0.001). The frailty group exhibited a higher incidence of chemotherapy toxicity at each time point compared to the non-frailty group (P < 0.001). Both frail and non-frail patients exhibited decreased chemotherapy toxicity at T2 (B=-1.250, P = 0.001) and T3 (B=-1.397, P < 0.001) of chemotherapy, compared to their toxicity at T1. Significant differences in hematologic (P = 0.008) and non-hematologic (P = 0.019) toxicities were identified between the frailty and non-frailty group. Conclusions A high prevalence of frailty was observed in patients with gastrointestinal tumors before chemotherapy, with a significant incidence of chemotherapy toxicity. The study highlighted the impact of frailty on long-term chemotherapy toxicity, including both hematologic and non-hematologic chemotherapy toxicity. Healthcare professionals should prioritize the frailty status of patients before chemotherapy, implement targeted interventions based on identified frailty risk factors, and develop personalized nursing strategies to mitigate frailty and reduce the incidence of chemotherapy toxicity.