International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2026
Frailty assessment in ovarian cancer: a systematic review of measurement definitions, methods, and clinical implications.
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Castelo-Loureiro Alicia, Alqaisi Husam, Fazelzad Rouhi, Rodríguez-Couso Myriam, Noronha Mariana M, Soto-Perez-de-Celis Enrique, Lheureux Stephanie, Oza Amit M, Madariaga Ainhoa
Аннотация
OBJECTIVE: To evaluate how frailty is defined and assessed in ovarian cancer studies, and whether these assessments inform clinical outcomes or are integrated into clinical decision-making.
METHODS: Studies assessing frailty across surgical, systemic therapy, and surveillance settings were included. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and was prospectively registered. Frailty assessment approaches were categorized as validated or multidimensional frailty assessments versus single-domain proxies or non-frailty constructs.
RESULTS: The search identified 5818 records; 3170 were screened after duplicate removal, 111 full-text articles were assessed, and 61 unique publications representing 54 studies or cohorts met broad eligibility criteria. Thirty-two publications (52.5%) used validated screening tools or multidimensional approaches and were retained for outcome synthesis; the remaining 29 (47.5%) relied on single-domain proxies or non-frailty constructs and were mapped separately. Validated screening tools were used in 6 publications, deficit-accumulation indices in 16 publications from 15 studies, and geriatric assessment-based approaches in 10 publications from 8 studies. Reported associations included post-operative complications, treatment tolerance and delivery, health care use, survival, and quality of life, although heterogeneity precluded quantitative synthesis. Clinical use of findings was seldom reported. Among the 27 studies with outcome comparisons, frailty or vulnerability was consistently associated with adverse outcomes. One study prospectively used a geriatric assessment-derived vulnerability score to define eligibility for a randomized treatment comparison. However, no study tested a multidomain care pathway in which individual geriatric deficits triggered targeted interventions and reassessment.
CONCLUSIONS: Frailty assessment in ovarian cancer remains heterogeneous, but it is consistently associated with adverse outcomes. The major gap is not the absence of assessment tools but their limited translation into clinical care. Future studies should distinguish chronic geriatric vulnerability from potentially reversible, tumor-related impairment and should test whether linking multidomain assessment findings to targeted interventions improves patient and treatment outcomes.
METHODS: Studies assessing frailty across surgical, systemic therapy, and surveillance settings were included. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and was prospectively registered. Frailty assessment approaches were categorized as validated or multidimensional frailty assessments versus single-domain proxies or non-frailty constructs.
RESULTS: The search identified 5818 records; 3170 were screened after duplicate removal, 111 full-text articles were assessed, and 61 unique publications representing 54 studies or cohorts met broad eligibility criteria. Thirty-two publications (52.5%) used validated screening tools or multidimensional approaches and were retained for outcome synthesis; the remaining 29 (47.5%) relied on single-domain proxies or non-frailty constructs and were mapped separately. Validated screening tools were used in 6 publications, deficit-accumulation indices in 16 publications from 15 studies, and geriatric assessment-based approaches in 10 publications from 8 studies. Reported associations included post-operative complications, treatment tolerance and delivery, health care use, survival, and quality of life, although heterogeneity precluded quantitative synthesis. Clinical use of findings was seldom reported. Among the 27 studies with outcome comparisons, frailty or vulnerability was consistently associated with adverse outcomes. One study prospectively used a geriatric assessment-derived vulnerability score to define eligibility for a randomized treatment comparison. However, no study tested a multidomain care pathway in which individual geriatric deficits triggered targeted interventions and reassessment.
CONCLUSIONS: Frailty assessment in ovarian cancer remains heterogeneous, but it is consistently associated with adverse outcomes. The major gap is not the absence of assessment tools but their limited translation into clinical care. Future studies should distinguish chronic geriatric vulnerability from potentially reversible, tumor-related impairment and should test whether linking multidomain assessment findings to targeted interventions improves patient and treatment outcomes.