Prevalence and predictors of frailty among older patients with lung cancer: a systematic review and meta-analysis.

[BACKGROUND] Older lung cancer patients with frailty are of higher risk of therapeutic side effects and mortality. Despite the fact that the estimated prevalence of frailty among older patients with lung cancer is widely reported, these results have not been synthesized. The aim of this review was to systematically assess the prevalence and related factors of frailty in older patients with lung cancer.

[METHODS] We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang databases for observational studies (published up to January 1, 2025) on the prevalence of frailty in older patients with lung cancer. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of included cohort or case-control studies, the Agency for Healthcare Research and Quality (AHRQ) tool was applied to assess the risk of bias in cross-sectional studies. Pooled estimates, subgroup analyses, meta-regression, and publication bias were conducted using Stata 17.0.

[RESULTS] In total, 44 articles comprising 61,587 patients were included in this study. The prevalence of frailty among older patients with lung cancer ranged from 5% to 91%, with an estimated prevalence of 46% [95% confidence interval (CI): 39-54%, I=99.6%]. Moreover, Egger's regression test suggested no publication bias (P=0.72). Subgroup analyses showed that frailty was more prevalent among female patients, and those older patients ≥70 years old, from developed countries, before radiotherapy, and assessed using the G8 tool.

[CONCLUSIONS] Frailty is prevalent among older patients with lung cancer, and factors such as age, gender, country, treatment status, and frailty tool were associated with frailty. However, the findings should be interpreted with caution due to high heterogeneity and limited data from regions and subgroups. Early and routine frailty assessment with appropriate management may improve prognosis in this population.