The intersection between frailty and unmet health-related social needs: Establishing the complex frailty paradigm.

96

Background: Older adults diagnosed with cancer (OAC) experience unique challenges that are often complicated by frailty. However, the extent to which frailty and frailty-mediated outcomes intersect with unmet health-related social needs (HRSN) and limited to marginal health literacy remains unknown. Here, we introduce the complex frailty phenotype among OAC and its impact on treatment outcomes. Methods: Before scheduled consultation at the Dana-Farber Cancer Institute Gastrointestinal Cancer Center (DFCI GCC), OAC age 65 years and older undergo an electronic frailty assessment (EFA): a modified Rockwood frailty scale evaluating general health, functional independence, social support, medication use, nutrition, and mood. Summary domain scores range from: 0-0.19 (robust), 0.20-0.34 (pre-frail), and 0.35-1.00 (frail). Additional questionnaires include a New Patient Intake Questionnaire to capture self-perceived health, personal and family history, HRSN questionnaire, and BRIEF health literacy screening tool, available in 6 languages (English, Spanish, Arabic, Chinese, Russian, and Haitian Creole). All OAC receiving treatment at DFCI GCC are referred to the Older Adults with Gastrointestinal Cancer Program to address unmet HRSN and frailty through integrated geriatric and pharmacy co-management, tailored health education, care coordination, and referrals to assistance programs. To explore the prevalence of complex frailty in this cohort, we defined complex frailty as pre-frail or frail OAC with any reported unmet HRSN and limited to marginal health literacy. Results: From January 2022 through November 2025, 2,877 out of 3,804 OAC (75.6%) evaluated at DFCI GCC completed EFA (1,983 robust, 620 pre-frail, and 274 frail). Between April 2023 through November 2025, 27.1% of OAC reported any unmet need (43.1% financial needs, 37.5% housing needs, 29.4% transportation needs, 20.1% nutrition needs, 19.8% caregiving needs, 5.6% digital access needs, and 3.0% education needs (n=2,311). For OAC reporting unmet HRSN, 49.4% were pre-frail or frail vs. 23.0% among those with no reported HRSN (p>0.0001). Of those with unmet HRSN and limited/marginal health literacy, 60.2% were pre-frail or frail vs. 24.1% of those with either no reported unmet HRSN or health literacy scored adequate (p<0.0001). Conclusions: Frailty compounded by unmet HRSN and low health literacy may prognosticate worse outcomes for OAC with gastrointestinal cancers. Increased recognition of complex frailty and tailored interventions is necessary for this growing population. Our future work will examine the impact of interventions addressing both frailty and HRSN on survival outcomes for our OAC at DFCI and beyond. Clinical trial information: NCT04674267 .