Frailty Predicts Fewer Days at Home After Ovarian Cancer Surgery

Key Clinical Summary

• Frailty was the strongest predictor of fewer days spent alive and at home during the year after ovarian cancer surgery among Medicare beneficiaries aged 66 years and older.
• Frail patients experienced substantially worse functional recovery despite shorter-term surgical outcomes often appearing acceptable.
• Minimally invasive surgical approaches were associated with more days at home, while high-risk procedures and surgery without chemotherapy were associated with fewer days at home.

As the population of older adults with ovarian cancer continues to grow, new research suggests that frailty—not chronological age—is the most important predictor of long-term recovery after surgery.

In a population-based analysis of more than 7300 Medicare beneficiaries undergoing surgery for ovarian, fallopian tube, or primary peritoneal cancer, frailty was strongly associated with fewer days spent alive and at home during the year following surgery, highlighting the importance of incorporating geriatric assessment into treatment planning.

Frailty Emerges as the Strongest Predictor of Recovery

Investigators analyzed Medicare claims data from 2013 through 2020, identifying 7348 patients aged 66 years and older who underwent ovarian cancer surgery.

Using a validated claims-based frailty index, patients were classified as robust (44.0%), prefrail (49.8%), or frail (6.2%).

The study’s primary outcome was days at home (DAH), a patient-centered measure reflecting the number of days patients spent alive and outside hospitals, nursing facilities, rehabilitation centers, and other institutions during the first year after surgery.

Overall, patients spent a mean of 323 days at home during the year following surgery.

However, outcomes differed substantially according to frailty status. Robust patients averaged 330 days at home, compared with 315 days among prefrail patients and only 269 days among frail patients (P < .001).

Notably, frailty remained the strongest independent predictor of reduced days at home after adjustment for age, comorbidities, treatment approach, and surgical factors. Frailty was associated with a loss of 52 days at home during the first postoperative year.

Mortality Drives Long-Term Loss of Independence

The study found that hospitalizations and nursing facility stays accounted for most lost days during the first 90 days after surgery.

Beyond 90 days, mortality became the primary contributor to reduced days at home.

One-year mortality rates were 27.8% among frail patients, compared with 16.7% among prefrail patients and 8.8% among robust patients.

Importantly, investigators found that robust patients aged 80 years and older had more days at home than frail patients younger than 70 years, reinforcing the limited value of age alone when assessing surgical candidacy.

Surgical Approach Influences Functional Recovery

Several potentially modifiable treatment factors were associated with postoperative recovery.

High-risk surgical procedures, including bowel resections, were associated with 30 fewer days at home during the first year after surgery.
Patients who underwent surgery without chemotherapy experienced 23 fewer days at home.

Conversely, minimally invasive surgery was associated with 28 additional days at home compared with open surgical approaches.
The authors noted that frail patients were more likely to undergo open surgery and high-risk procedures despite evidence that less invasive approaches may improve recovery in selected patients.

Implications for Clinical Practice

The findings underscore the growing importance of patient-centered outcomes in older adults with cancer.

Traditional surgical benchmarks such as 30-day morbidity and mortality may fail to capture outcomes most meaningful to older patients, including independence, quality of life, and time spent at home.

The authors argue that routine frailty assessment should become a standard component of ovarian cancer surgical evaluation and counseling. Such assessments may help identify patients who are likely to benefit from surgery while also supporting more individualized discussions regarding treatment goals, recovery expectations, and alternative strategies such as neoadjuvant chemotherapy.

Conclusion

Among older adults undergoing ovarian cancer surgery, frailty was a stronger predictor of postoperative recovery than age alone. Incorporating frailty assessment into surgical decision-making may improve patient-centered care, support shared decision-making, and help optimize functional outcomes following treatment.

Reference

Cham S, Gan S, Boscardin W J, et al. Frailty and days at home after ovarian cancer surgery— a patient-centered outcome for older adults. JNCCN. 2026;24(4). doi: 10.6004/jnccn.2025.7124