No abstract

Objectives: Routinely used performance status scales, assessing patients' suitability for cancer treatment, have limited ability to account for multimorbidity, frailty and cognition. The Clinical Frailty Scale (CFS) is a suggested alternative, but research detailing its use in oncology is limited. This study aims to evaluate if CFS is associated with prognosis and care needs on discharge in oncology inpatients.Methods: We evaluated a large, single-centre cohort study in this research. CFS was recorded for adult inpatients at a Regional Cancer Centre. The associations between CFS, age, tumour type, discharge destination and care requirements and survival were evaluated.Results and Conclusions: A total of 676 patients were included in the study. Levels of frailty were high (Median CFS 6, 81.8% scored ≥5) and CFS correlated with performance status (R = 0.13: P = 0.047). Patients who were frail (CFS ≥ 5) were less likely to be discharged home (62.9%) compared with those who were not classed as frail (86.1%) (OR 3.6 [95%CI 2.1 to 6.3]: P < 0.001). Higher CFS was significantly associated with poorer prognosis in all ages. Solid organ malignancy (hazard ratio [HR] 2.60 [95%CI 2.05-3.32]) and CFS ; P < 0.001) were independently associated with poorer survival. This study demonstrated that CFS may help predict prognosis in adult oncology inpatients of any age. This may aid informed shared decision-making in this setting. Future work should establish if routine CFS measurement can aid the appropriate prescription of systemic therapy and enable early conversations about discharge planning.

Indications (n) chest sepsis (3), perforated viscus (2), colitis (1), bacteraemia (1), alcoholic hepatitis (1), urinary tract infection (1), unclear source (2).The median antibiotic course length was 5 days (1-14). Median WCC: 13.8X10 9 cells per litre (3.6 to 45); Median C-reactive protein: 119.1mg/L (7 to 204).Continuation of an antibiotic course was more likely if an IV cannula was in situ, and less likely when there was an alternative diagnosis.A decision to prescribe antibiotics was documented as preemptively discussed with the patient in only 1%. Conclusions 1. A significant proportion of patients that are identified as being in their last weeks of life are prescribed antibiotics 2. Decisions about antibiotic prescribing and ceilings of care were made as part of routine clinical care. This was without patient involvement and was not as a part of an ACP.3. ACP, specifically including antibiotic use should be standard practice for all patients admitted to a specialist inpatient palliative care unit.4. More research is needed, including evaluating patient acceptability.