Cardiopulmonary Exercise Testing Versus Frailty, Measured by the Clinical Frailty Score, in Predicting Morbidity in Patients Undergoing Major Abdominal Cancer Surgery

Abstract

Background The primary outcome of this study is to investigate the association between the cardiopulmonary exercise testing (CPET) variables: anaerobic threshold (AT), peak oxygen uptake (VO 2 peak), peak work rate (WR), ventilatory equivalence of CO 2 (VE/VCO 2 ) at the anaerobic threshold (AT) with frailty, measured by the clinical frailty scale (CFS) in patients planned to undergo major abdominal cancer surgery. The secondary outcome is to compare the CPET variables (VO 2 peak, peak WR, VE/VCO 2 at AT) with frailty measured by the CFS in predicting postoperative surgical morbidity in patients following major abdominal cancer surgery. Methods This study was a single-centre prospective cohort analysis of consecutive adult patients undergoing CPET and CFS scoring as part of their pre-operative work-up for major abdominal cancer surgery. Results A total of n = 317 patients underwent CPET and CFS assessment ahead of planned abdominal oncological surgery. Negative correlations were observed between the CPET variables: AT -0.42 p \ 0.01; VO 2 peak -0.53 p \ 0.01; peak WR -0.54 p \ 0.01 with CFS scores and a positive correlation between CFS scores and VE/VCO 2 0.29 p \ 0.01. Only CFS remained statistically significant in a multivariate model OR 2.11 (1.42-3.15) 95% CI associated with Clavien-Dindo (CD) C 1 defined morbidity including the significant univariate variables (VO 2 peak, peak WR and CFS scores). No variables were associated with CD C 3 morbidity. Conclusions In patients scheduled to have major abdominal cancer surgery there was a weak association between poor performance on CPET and increasing frailty measured by the CFS. The CFS score unlike CPET was associated with all post-operative morbidity, but not major complications alone, in these patients. This suggests that CFS may be used as a less expensive alternative to CPET for predicting any postoperative morbidity in major abdominal cancer surgery.

The Clinical Frailty Scale (CFS) employment in the frailty assessment of patients suffering from Non-Communicable Diseases (NCDs): A systematic review

“…Also, evidence reports a consistency between CFS scores attributed considering medical records and CFS scores attributed through interviews with patients or their families ( 89 ). Moreover, CFS should be administered by medical doctors, but, despite this, ten studies included in this review show that CFS is not always administered by physicians ( 42 , 46 , 55 – 57 , 59 , 68 , 70 , 75 , 77 ). This is made possible by the multidimensionality of this tool because it relies on data other than clinical judgment.…”

Exercise capacity prior to major cancer surgery: A cross‐sectional observational study of the validity of the 6‐minute walk and 30‐second sit‐to‐stand tests

“…Participant demographics included age, sex, and cancer type. The 6MWT, 30STS test, CPET variables, AKPS, 26 European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‐C30), 27 International Physical Activity Questionnaire‐Short Form (IPAQ‐SF), 28 Clinical Frailty Scale (CFS), 29 and Malnutrition Screening Tool 30,31 were collected at baseline.…”

“…Patients with cancer awaiting major surgery referred to a prehabilitation service were screened for eligibility. 27 International Physical Activity Questionnaire-Short Form (IPAQ-SF), 28 Clinical Frailty Scale (CFS), 29 and Malnutrition Screening Tool 30,31 were collected at baseline.…”

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

“…Frail patients with cancer have a poorer quality of life and a steeper deterioration in function (Kirkhus, Šaltytė, et al, 2019 ). Frailty is associated with increased complications from surgery and chemotherapy and consequently poorer prognosis (Cohen et al, 2016 ; Klingenschmid et al, 2022 ; O'Mahony et al, 2020 ). The importance of screening for frailty is increasingly recognised in the oncology and haemato‐oncology inpatient population.…”