Polypharmacy and frailty in geriatric oncology patients with advanced cancer: A prospective observational study

Older adults with advanced cancer often have comorbidities, experience a symptom burden, take multiple medications, and are frail. To examine the relationship between polypharmacy and frailty, and to identify the factors that contribute to frailty in geriatric oncology patients aged 65 years and over with stage III-IV cancer. This prospective, observational, cross-sectional study was conducted between September 2025 and March 2026 at a university hospital in Türkiye. Data were collected from 200 inpatient and outpatient geriatric oncology patients via structured interviews and analysis of their medical records. The following scales were used to assess ECOG Performance Status and Edmonton Frailty Status: ECOG Performance Status Scale and Edmonton Frailty Scale (EFS). Polypharmacy was defined as the concurrent use of ≥5 medications. Polypharmacy was present in 83.5% of patients, with more than three-quarters exhibiting some degree of frailty. In the multivariable analysis, polypharmacy was strongly associated with frailty (OR: 8.22, 95% CI: 2.13–31.64, p=0.002). Older age (OR: 1.18, 95% CI: 1.06–1.32, p=0.003), stage IV cancer (OR: 2.79, 95% CI: 1.07–7.29, p=0.036), pain (OR: 4.45, 95% CI: 1.38–14.36, p=0.013), a history of falls (OR: 25.57, 95% CI: 1.96–334.10, p=0.013), and inpatient treatment setting (OR: 7.39, 95% CI: 1.99–27.50, p=0.003) were also independently associated with higher odds of frailty. The model demonstrated excellent discrimination (AUC = 0.934, 95% CI: 0.899–0.968). Polypharmacy is highly prevalent and strongly associated with frailty in geriatric oncology patients with stage III-IV cancer. Pain management, nutritional support and patient safety should also be considered for this group of patients. Further longitudinal studies are required to clarify the direction of this relationship and evaluate targeted interventions.