Exploring the intersection of cancer, sepsis, and frailty: a scoping review

To explore the intersection of cancer, sepsis, and frailty, and consider potentials for rehabilitation interventions to manage these conditions.

We conducted a scoping review guided by the Joanna Briggs Institute’s framework. We searched seven databases for studies that included: (1) adults > 18 years of age; (2) with a current or past diagnosis of cancer; (3) a current or past diagnosis of sepsis; (4) explicitly identified frailty as an inclusion criterion; (5) explored the intersection of these condition; and (6) were published in English. We screened titles/abstracts, reviewed full texts, and performed data extraction in duplicate. A qualitative synthesis summarized findings related to the "population, context, concept” framework.

Of 2083 citations, we included 18 studies, which included 3,206,672 participants. Most (61%) were retrospective cohort studies of acute hospital datasets collected in the United States. Fourteen (78%) of the studies explicitly defined frailty, however there was inconsistency in frailty measurement, with 12 unique tools described. Only two studies (11%) provided criteria for diagnosing sepsis. Of 17 studies exploring the effect of frailty on risk of sepsis in those with cancer, 10 (59%) found a statistically significant association between increased frailty and number of poor outcomes.

It appears frailty is associated with an increased risk of sepsis in those with cancer. Sepsis is not well reported on in the literature and future research standardizing measures of frailty would help further evaluating the association of these conditions. It remains uncertain whether rehabilitation strategies could maximize function in this population.