Lack of a systematic approach and unified standards in frailty assessment among patients with gastric cancer: a scoping review

Introduction Frailty is closely linked to gastric cancer outcomes, yet research on frailty assessment in this population remains fragmented.Objective To map frailty assessment practices in gastric cancer and identify gaps and priorities for research.Methods Following Arksey and O'Malley's framework and Joanna Briggs Institute guidance, we searched 15 Chinese and international databases from inception to 17 February 2026 without language restrictions. Data were charted descriptively and presented using tables and heatmaps.Results Seventy-four studies (2014-2025; total n = 90,856) were included. These studies used seven designs, were mainly conducted in East Asia among older adults, and employed 19 frailty assessment tools. Frailty assessments were conducted in hospital settings (100%), with preoperative assessment accounting for the highest proportion (81.08%), and the majority utilising a single assessment point (93.24%). Researchers were the primary assessors (90.54%). In studies that enrolled unselected gastric cancer populations, the pooled proportion of frailty was 30.57% (range across studies, 9.41%-75.64%), indicating that frailty is common in this population. Assessment content clustered into five domains, with physiological assessment dominating the focus. Conversely, the psychological (39.19%) and social (17.57%) dimensions were relatively scarce. The research objectives mainly focused on clinical characteristics and prognosis (51.35%). Mechanistic studies (8.11%), longitudinal studies (4.05%), and assessment tool comparison studies (1.35%) were notably scarce.Conclusions Frailty is common in gastric cancer. However, frailty assessment practices remain heterogeneous, fragmented, and predominantly physiologically oriented. Future work should prioritise standardised frameworks, integration of psychosocial dimensions, longitudinal monitoring, elucidation of the underlying mechanisms of frailty, and the development of evidence-based multimodal interventions.Registration The study protocol was registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/DFX6K).