The Role of Frailty in Cardio-oncology and its Challenges

Frailty has received increasing scientific attention as a potential explanation for adverse health outcomes among older adults. In cardio-oncology, frailty is particularly relevant due to the dual burden of cardiovascular disease and cancer, both of which accelerate the general decline in health associated with ageing. Therefore, understanding and addressing frailty in cardio-oncology has paramount importance for optimising patient outcomes, personalising treatment plans, and improving quality of life. In this review, we aim to discuss: the pathophysiology of frailty in the context of cardio-oncology; the common frailty definitions used in observational studies and in clinical drug trials among patients with cancer; the challenges of frailty assessments in cardio-oncology; and the need to incorporate frailty into cardiovascular risk assessment tools in older patients with cancer. Further research is needed to better understand the underlying mechanisms linking frailty to cardiotoxicity and to explore potential interventions that may mitigate these risks in cancer patients.