Frontiers in Oncology · Jun 16, 2026

Influencing factors of cognitive frailty in older patients with esophageal cancer undergoing chemotherapy: a mixed-methods study

By Wang F, Gu Z, Jia Y et al.

OBJECTIVE: To examine the prevalence of cognitive frailty and its associated factors among older patients with esophageal cancer undergoing chemotherapy, and to provide evidence for the development of targeted nursing interventions. METHODS: Based on the biopsychosocial model, an explanatory sequential mixed-methods study design was employed. A convenience sample of 246 older patients with esophageal cancer receiving chemotherapy was recruited from two tertiary general hospitals in Yangzhou City between July and December 2025. Data were collected using a general information questionnaire, the Frailty Phenotype Scale, the Montreal Cognitive Assessment, the Nutritional Risk Screening 2002 (NRS-2002), the Athens Insomnia Scale, the 15-item Geriatric Depression Scale (GDS-15), and age-adjusted Charlson comorbidity index (aCCI). Binary logistic regression analysis was performed to identify factors associated with cognitive frailty. From January to February 2026, 15 patients who met the criteria for cognitive frailty were purposively selected from the quantitative sample to participate in semi-structured interviews. Qualitative data were analyzed using Colaizzi's seven-step method. RESULTS: The incidence of cognitive frailty among older patients with esophageal cancer undergoing chemotherapy was 45.1%. Quantitative analysis identified chemotherapy cycles, nutritional risk, sleep disturbances, depression, educational attainment, participation in cognitive training activities, and social support as significant factors associated with cognitive frailty (p < 0.05). CONCLUSION: Cognitive frailty is relatively common among older patients undergoing chemotherapy for esophageal cancer and is influenced by multiple interrelated factors. Healthcare professionals should strengthen assessment and management during chemotherapy and develop targeted interventions to reduce the risk of cognitive frailty.

doi.org/10.3389/fonc.2026.1843050 Open access PubMed 42382395 Populations