Frailty and Oncology: An Increasingly Common Combination

Abstract

Background: Frailty is defined by a reduction in physiological reserve and an increased vulnerability to stressors. In oncology,frailty is highly prevalent and has been consistently associated with a worse prognosis. The aim of this manuscript is to under-stand the interaction between frailty and cancer to optimise therapeutic decision-making and improve patient-centred outcomes.Methods: A narrative literature review was conducted using the PubMed database, with articles published up to July 2025included. The search terms used included "frailty", "oncology", "cancer", "malignancy", "diagnosis", "optimisation", "treatment"and "prognosis". In accordance with the protocol, the following documents were prioritised: clinical guidelines, systematic andnarrative reviews, observational studies, and randomised clinical trials.Results: Frailty has been shown to independently predict postoperative morbidity, chemotherapy toxicity, functional de-cline, and mortality. This can result in both undertreatment and overtreatment. Consequently, frailty assessment has emergedas a cornerstone of personalised oncology, enabling treatment individualisation beyond tumor characteristics alone. While aComprehensive Geriatric Assessment remains the gold standard for frailty evaluation, screening tools should be used to facilitaterisk stratification in routine practice. Incorporating frailty into decision-making processes has been shown to reduce inappropri-ate undertreatment and overtreatment, improve treatment tolerance, and facilitate shared decision-making. Multimodal, patient-centred interventions, such as exercise, nutritional support, medication optimisation, psychosocial care, and early palliativeintegration, mitigate frailty, enhance quality of life, and support adherence to individualised therapeutic plans. Oncogeriatricmodels of care further operationalise personalised medicine by coordinating these interventions within multidisciplinary teams.Conclusion: It is crucial to acknowledge frailty as a pivotal clinical variable, rather than considering it a contraindication to can-cer treatment. Health systems should promote structured frailty evaluation, professional training, and institutional pathways toensure equitable, patient-centred management of frail individuals with cancer. Integrating frailty into oncology clinical practiceoperationalises personalised medicine by shifting the focus from treating the disease to treating the whole patient.