The Clinical Frailty Scale as predictor of overall survival after resection of high-grade glioma

Abstract

Background The Clinical Frailty Scale (CFS) describes the general level of fitness or frailty and is widely used in geriatric medicine, intensive care and orthopaedic surgery. This study was conducted to analyze, whether CFS could be used for patients with high-grade glioma. Methods Patients harboring high-grade gliomas, undergoing first resection at our center between 2015 and 2020 were retrospectively evaluated. Patients’ performance was assessed using the Rockwood Clinical Frailty Scale and the Karnofsky Performance Scale (KPS) preoperatively and 3–6 months postoperatively. Results 289 patients were included. Pre- as well as postoperative median frailty was 3 CFS points (IqR 2–4) corresponding to “managing well”. CFS strongly correlated with KPS preoperatively (r = − 0.85; p < 0.001) and at the 3–6 months follow-up (r = − 0.90; p < 0.001). The reduction of overall survival (OS) was 54% per point of CFS preoperatively (HR 1.54, CI 95% 1.38–1.70; p < 0.001) and 58% at the follow-up (HR 1.58, CI 95% 1.41–1.78; p < 0.001), comparable to KPS. Patients with IDH mutation showed significantly better preoperative and follow-up CFS and KPS (p < 0.05). Age and performance scores correlated only mildly with each other (r = 0.21…0.35; p < 0.01), but independently predicted OS (p < 0.001 each). Conclusion CFS seems to be a reliable tool for functional assessment of patients suffering from high-grade glioma. CFS includes non-cancer related aspects and therefore is a contemporary approach for patient evaluation. Its projection of survival can be equally estimated before and after surgery. IDH-mutation caused longer survival and higher functionality.

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

“…However, this is the first study focussing specifically on its use in oncology and haemato‐oncology inpatients (Church et al, 2020 ). Unlike other oncology studies, we found a relatively weak correlation between CFS and PS, and PS did not independently predict survival (Klingenschmid et al, 2022 ; Shah et al, 2022 ). This highlights the challenge of assessing PS in the inpatient setting, where patients may have limited opportunities for mobilisation and self‐care, and rapid changes in physiology and function can occur.…”

“…Frailty is an increasingly commonly used construct in modern healthcare. Our study supports the use of the CFS in oncology and haematology (Klingenschmid et al, 2022 ; Shah et al, 2022 ; Wall et al, 2021 ) . Recognising the implications of frailty may help healthcare professionals discuss the risks and benefits of potential treatments with patients and their families.…”

“…Frailty measured using the CFS has been found to correlate with prognosis across a range of patient populations including outpatients with hepatobiliary, central nervous system and haematological malignancies (Klingenschmid et al, 2022 ; Shah et al, 2022 ; Wall et al, 2021 ). However, this is the first study focussing specifically on its use in oncology and haemato‐oncology inpatients (Church et al, 2020 ).…”

“…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.…”

Age-Dependent Impact of Concomitant Radio-Chemotherapy and MGMT Promotor Methylation on PFS and OS in Patients with IDH Wild-Type Glioblastoma: The Real-Life Data

“…Nowadays, biological but not chronological age in combination with frailty have more impact on the decision making in cases of malignant glioma [ 16 , 17 ]. Thus, our center generally offers aggressive tumor resection and concomitant radio-chemotherapy to elderly patients with low frailty.…”