Risk factors for frailty in older adults with cancer: a systematic review

Abstract

Frailty and cancer interact bidirectionally and synergistically, exacerbating multiple adverse clinical outcomes in elderly patients. Accelerated global population aging has led to a continuous rise in the incidence of cancer among older adults, who inherently represent a high-risk population for frailty. Antitumor therapies further elevate the risk of frailty and impair long-term prognosis. Nevertheless, existing systematic reviews lack stratified integration of cross-sectional correlational evidence and longitudinal predictive evidence of frailty risk factors in older cancer survivors, and comprehensive categorized summaries of relevant variables remain scarce. We electronically searched PubMed, Embase and Web of Science from database inception to July 2025 using a combination of subject headings and free-text terms. Reference tracing of included articles was performed to supplement potential eligible studies. Three researchers independently completed literature screening per predefined eligibility criteria, while two investigators extracted data and conducted mutual cross-verification. A total of 30 studies published between 2014 and 2025 were incorporated, adopting multiple validated frailty assessment scales. Among them, 26 cross-sectional studies only identified coexistent correlational factors of frailty, and 4 longitudinal cohort studies screened independent predictors for the onset and progression of frailty. The influencing factors were divided into six categories: disease-related, physiological, psychological, lifestyle, sociodemographic and treatment-related factors. Frailty in older adults with cancer is affected by multi-dimensional, complex determinants. Targeted screening and intervention strategies can be formulated upon identification of these factors to reduce frailty incidence and improve clinical prognosis.