Pre-frailty and frailty as predictors of mortality among colorectal cancer survivors: Evidence from the National Health Interview Survey (1997–2018)

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. We conducted a prospective survival analysis using data from the 1997 to 2018 National Health Interview Survey, linked to mortality outcomes through December 31, 2019, via the National Death Index. Frailty status was determined using a modified fatigue, resistance, ambulation, illnesses, and low body mass index 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. Among 4052 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% confidence interval, 1.21-1.71; P < .001; HR for frail, 2.19; 95% confidence interval, 1.89-2.56; P < .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. Frailty and pre-frailty are common among colorectal cancer survivors and are independently associated with increased risk of all-cause mortality. Frailty assessment may help identify vulnerable colorectal cancer survivors and inform risk stratification in survivorship care planning.