Prevalence of Frailty and Its Predictors Among Patients With Cancer at the Chemotherapy Stage: Systematic Review
Bibliographic record
Abstract
Background: Chemotherapy causes physiological, psychological, and social impairments in patients with cancer. Frailty reduces the effectiveness of chemotherapy and increases the toxicity associated with radiotherapy and chemotherapy, the possibility of chemotherapy failure, and adverse outcomes. However, factors affecting chemotherapy-related frailty in patients with cancer remain unclarified. Objective: This systematic review aimed to identify risk factors driving frailty progression during chemotherapy in patients with cancer. Methods: A comprehensive systematic search was conducted on PubMed, Web of Science, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database (VIP), and SinoMed for observational studies (cohort, cross-sectional, or case-control) on factors affecting the debility-of-chemotherapy stage in patients with cancers between the inception of the database and February 2025, with an updated search executed in May 2025. Literature screening, quality evaluation using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality checklist, and data extraction were conducted independently by 2 authors. Meta-analysis, effect size combination, sensitivity analysis, and publication bias analysis were performed using RevMan (version 5.4; The Cochrane Collaboration) and R (version 4.4.3; R Foundation). Results: The analysis comprised 14 studies (8 cross-sectional, 2 repeated cross-sectional, 3 cohort, and 1 mixed-design), including 3879 patients with cancer and 23 influencing factors. Methodological quality assessment using Agency for Healthcare Research and Quality (mean 8.8, SD 1.3, 95% CI 7.9-9.7; SE 0.4) and Newcastle-Ottawa Scale (mean 8.0, SD 1.0, 95% CI 6.7-9.3; SE 0.6) revealed 73% (8/11) of cross-sectional studies as high-quality. The meta-analysis showed a 35% (95% CI 22%-50%) prevalence of frailty during chemotherapy in these patients. Cancer stage (odds ratio 1.99, 95% CI 1.64-2.42), chemotherapy frequency (odds ratio 2.60, 95% CI 1.83-3.70), transfer (odds ratio 2.18, 95% CI 1.50-3.17), hemoglobin (odds ratio 0.29, 95% CI 0.18-0.47), white blood cell (odds ratio 0.37, 95% CI 0.21-0.65), comorbidity (odds ratio 1.93, 95% CI 1.30-2.86), and hypoproteinemia (odds ratio 1.74, 95% CI 1.31-2.30) were risk factors for frailty in patients at the chemotherapy stage. Conclusions: Frailty during chemotherapy was strongly associated with advanced cancer stage, frequent treatment cycles, metastasis, anemia, leukopenia, comorbidities, and hypoproteinemia. Clinically actionable findings emphasized hemoglobin and albumin monitoring as preventive targets, while heterogeneity in assessment tools and population bias limited generalizability. The integration of frailty screening into chemotherapy workflows is urgent to mitigate treatment-related functional decline.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.039 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.011 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".