In older persons with colorectal cancer (CRC), frailty is a multifaceted state of decreased physiological reserve that can impact recovery, quality of life and treatment tolerance. The evidence on frailty assessment and CRC outcomes is summarized in this narrative review, with a focus on pharmacy-practice interventions that can convert evaluation into safer, more customized care. Although results vary by instrument, demographic and treatment environment, there is evidence linking frailty to postoperative morbidity, therapeutic toxicity, inadequate therapy, functional decline and lower survival. Medication burden, comorbidities, nutrition, cognition, function and social support needs can all be identified by a thorough geriatric evaluation. Medication reconciliation, screening for potentially inappropriate medications and interactions, organ-function-related dosage review, adherence support, toxicity education and communication with the multidisciplinary team are some ways pharmacists can help. There is encouraging evidence for pharmacist-led medication optimization in geriatric oncology, although it is not CRC-specific and is still scarce. While biomarkers, digital phenotyping and artificial intelligence are still under investigation, prehabilitation, sarcopenia assessment and long-term monitoring may enhance therapy. Oncological judgment and collaborative decision-making should be complemented, not replaced, by frailty-informed pharmacological care.
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