Frailty and Health-related Quality of Life in Older Women With Breast Carcinoma

Functional status will be evaluated using Activities of Daily Living (ADL) (assessing bathing, dressing, toileting, transferring, eating, and continence; Katz, 1970) and Instrumental ADL (IADL) (assessing shopping, cooking, medication management, phone use, housework, laundry, transportation, and finances; Lawton & Brody, 1969). Nutritional status will be measured via the Mini-Nutritional Assessment-Short Form (MNA-SF) (Arabic version; Abd-Al-Atty et al., 2012), a 6-item tool (appetite, weight loss, mobility, illness, neuropsychological issues, BMI) scored 0-14, classifying patients as well-nourished (≥12), at risk (8-11), or malnourished (0-7; Rubenstein et al., 2001). Cognition will be assessed using the Saint Louis University Mental Status (SLUMS) exam (Arabic version; Abdelrahamn et al., 2014), a 30-point test evaluating calculation, orientation, memory, fluency, and visuospatial function, with dementia thresholds at \<20 (\<12 years education) or \<21 (≥12 years; Tariq et al., 2006).

Quality of life assessment by European Organization for Research and Treatment-Quality of life questionnaire and breast cancer-specific module (EORTC QLQ-C30)and QLQ-BR23) EORTC QLQ-C30 is a validated tool designed to measure cancer patients' physical, psychological and social functions. It consists of 30 items measuring Global Health status (2 items), Functional scales (15 items) and Symptoms scales/items (13 items). Items were measured using a 4-point Likert Scale ranging from Not at all (1) to Very much (4). EORTC-BR23 consists of 23 items which measure two main scales Functional Scale (8 items) and Symptoms scales (15 items). Items measured using 4-point Likert Scale ranging from Not at all (1) to Very much (4).

Frailty will be assessed using the Clinical Frailty Scale (CFS), a validated and widely used tool developed by (Rockwood et al., 2005). The CFS is a 9-point ordinal scale that categorizes older adults based on their level of physical fitness, functional independence, and comorbidities, ranging from 1 indicate very fit to 9 indicate terminally ill. Participants were evaluated by trained clinicians based on their clinical judgment, incorporating information from patient interviews. The scale provides a practical and reliable measure of frailty in geriatric populations and has demonstrated strong predictive validity for adverse health outcomes including hospitalization, institutionalization, and mortality.