Strategies for Dealing with Frailty
- Help patients become stronger so they can tolerate stronger, more effective treatments
- Use neoadjuvant chemotherapy–chemotherapy before surgery–to give patients time to prepare for surgery
- Choose chemotherapy with lower doses that are gentler to the body
Surgery and chemotherapy are the main treatments for ovarian cancer, and while both are very effective, they can be tough on the body. Since ovarian cancer often occurs in women over the age of 50–and many much older–doctors have to determine whether their patients are strong enough to withstand powerful anti-cancer treatments. Patients who are considered frail–meaning there’s reason to believe they may not be able to tolerate the usual cancer treatments–present a treatment dilemma.
"Frailty is a really complex … I don’t want to say problem, because it’s not necessarily a problem. It’s something that happens as people age. It can happen with chronic medical conditions,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle. Frailty doesn’t just affect older people, although it’s much more common as people age. Frailty can also be a result of other medical conditions that weaken the body in younger women, too. And sometimes ovarian cancer itself, especially if not diagnosed before it’s more advanced, can cause frailty.
Read More A common treatment recommendation after a diagnosis of ovarian cancer is
debulking surgery–an operation to remove as much visible tumor as possible. This is usually a very lengthy operation through a long incision in the abdomen, and it involves removing the ovaries, uterus, fallopian tube and often parts of other structures in the abdomen and pelvis such as the omentum (a fatty apron that covers many organs) and sections of the bowel. It’s major surgery even for someone who is otherwise strong and has no other medical conditions, but for someone frail it may be difficult to tolerate. If doctors believe a woman is too frail to withstand a large debulking operation, they may instead recommend a
minimally-invasive laparoscopic procedure. Instead of a large, open incision, doctors can perform the operation through lighted instruments inserted into several small incisions. Another strategy for treating frail patients is for doctors to use
neoadjuvant chemotherapy–chemotherapy before surgery–so that they can postpone surgery until patients get stronger. But even chemotherapy poses challenges when a patient is frail. “Certainly studies have shown that frail patients have higher risks and side effects from chemotherapy, and there have been studies done showing we can modify chemotherapy for ovarian cancer to be given to avoid large doses at one time to make it more tolerable for patients,” says Dr. Urban.
Patients who are considered frail may also be counseled to take steps to get stronger so that they can better withstand effective treatments. Eating better, sleeping more, sometimes gaining weight, engaging in exercise or getting physical therapy are all lifestyle measures that can help patients get stronger before medical treatment.
"I do think it’s important for all providers to address whether there are characteristics of frailty for each of our patients,” says Dr. Urban. “We incorporate that when we talk to patients and their family and/or care providers about both the pros and cons of treatment. And we address how treatment can be changed to make it more tolerable if we’re concerned that a patient is more frail."
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Dr. Renata Urban is a gynecologic oncologist at the University of Washington. Read More
