The Clinical Frailty Scale can indicate prognosis and care requirements on discharge in oncology and haemato‐oncology inpatients: A cohort study

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.

Geriatric screening and frailty intervention in older patients with cancer

“…Side 2 af 10 Clinical Frailty Scale (CFS) er et screeningsvaerktøj, der i tiltagende grad anvendes til vurdering af skrøbelighed hos aeldre patienter generelt, og CFS findes ligeledes i en dansk valideret udgave [17]. CFS scores på en skala fra 0 til 9 baseret på et klinisk skøn, hvor en score på ≥ 5 definerer skrøbelighed [18]. CFS er endnu kun sparsomt anvendt inden for onkogeriatrisk forskning.…”

“…CFS er endnu kun sparsomt anvendt inden for onkogeriatrisk forskning. I et kohortestudie har man påvist en association mellem skrøbelighed fundet ved CFS og et øget plejebehov ved udskrivelse samt øget dødelighed [18]. Der foreligger endnu ikke publicerede danske onkogeriatriske studier, hvor CFS anvendes.…”

Geriatric Oncology as an Unmet Workforce Training Need in the United Kingdom—A Narrative Review by the British Oncology Network for Undergraduate Societies (BONUS) and the International Society of Geriatric Oncology (SIOG) UK Country Group

“…Although international guidance exists recommending that frailty is assessed in older adults being considered for chemotherapy [28], this is not routine in the UK. However, the Rockwood Clinical Frailty Scale (CFS) [29] has been increasingly used to identify frail patients who may benefit from the input of specialist geriatric or oncogeriatric services in specific geographic regions [30,31]. The upcoming national guidance from the JCCO may further support the more widespread use of frailty assessments and development of pathways for specialist input within the UK.…”

Timely integration of palliative care into cancer care

“…Stoppelenburg et al showed that the Surprise Question predicts death in hospitalised patients with cancer reasonably well and can help to initiate palliative care earlier (Stoppelenburg et al, 2022). Another tool is the Clinical Frailty Scale (CFS), although still limited used in oncology, Welford et al showed that in adult oncology inpatients, the CFS is associated with prognosis and care needs on discharge and may help predict prognosis in adult oncology inpatients (Welford et al, 2022). Also, awareness of patients with incurable cancer and their relatives is an important issue.…”

“…One tool for identify patients with potential palliative care needs is the Surprise Question “Would I be surprised if this patient died in the next 12 months?” Stoppelenburg et al showed that the Surprise Question predicts death in hospitalised patients with cancer reasonably well and can help to initiate palliative care earlier (Stoppelenburg et al, 2022). Another tool is the Clinical Frailty Scale (CFS), although still limited used in oncology, Welford et al showed that in adult oncology inpatients, the CFS is associated with prognosis and care needs on discharge and may help predict prognosis in adult oncology inpatients (Welford et al, 2022).…”