The Rockwood Geriatric Clinical Frailty Scale is a more discriminatory tool for assessing older cancer patients compared with standard oncology performance status scales

Denholm, Mary; Corrie, Pippa; Qian, Wendi; Hampton, Joanna

doi:10.1016/j.ejso.2017.10.178

Cited by 8 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The CARG score will be calculated from 11 prechemotherapy variables. 15 Patients will be categorised into low (0-5), intermediate (6)(7)(8)(9) and high (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) risk. Observed grade 3-5 toxicity rates between groups will be compared using a χ 2 test of proportions.…”

Section: Statistical Analysis Planmentioning

confidence: 99%

“…Oncology Group performance status as a crude assessment tool for this purpose in patients of all age groups, despite it being shown to poorly correlate with frailty. 6 Research into the utility of frailty scores in aiding chemotherapy decision-making is limited. Therefore, most clinical decisions are underpinned by heuristic learning obtained through clinical practice despite clinicians having a tendency to overestimate benefit and underestimate harm.…”

Section: Introductionmentioning

confidence: 99%

“…11 Incorporation of frailty screening within oncology has been under review for some time and several different tools have been appraised to help predict mortality and chemotherapy toxicity, 12 including the International Society of Geriatric Oncology Geriatric Screening Tool (G8) 13 and Rockwood Clinical Frailty Score (CFS). 6 Although these tools have all been demonstrated to have utility in identifying frailty, none have been studied as predictive markers of chemotherapy toxicity.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Observational study investigating Tolerance Of Anticancer Systemic Therapy In the Elderly (TOASTIE): a protocol

et al. 2021

View full text Add to dashboard Cite

IntroductionThe number of older adults diagnosed with cancer is increasing. Older adults are more likely to have pre-existing frailty, which is associated with greater chemotherapy-related toxicity. Early identification of those at risk of toxicity is important to reduce patient morbidity and mortality. Current chemotherapy toxicity prediction tools including the Cancer and Ageing Research Group (CARG) tool exist but are not in routine clinical use and have not been prospectively validated in a UK population. This study is the first prospective study to investigate the CARG tool in a UK population with cancer.Methods and analysisTolerance Of Anticancer Systemic Therapy In the Elderly is a prospective observational study of patients, aged ≥65 years, commencing first-line (any indication) chemotherapy for a solid-organ malignancy. Patients receiving other systemic anticancer agents or radiotherapy will be excluded. The primary objective will be to validate the ability of the CARG score to predict grade 3+ toxicity in this population. Secondary objectives include describing the feasibility of screening for frailty, as well as the prevalance of frailty in this population and assessing patient and clinician perception of chemotherapy toxicity risk. 500 patients will be recruited over a two year period. Baseline assessments will be recorded. At the end of the 6-month follow-up period, toxicity data will be retrospectively collected. A descriptive analysis of the recruited population will be performed. The validity of the CARG model will be analysed using receiver-operating characteristic curves and calculation of the area under the curve (c-statistic).Ethics and disseminationThe study has received ethical approval from the East of Scotland Research Ethics Service 20/ES/0114. Results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media.

show abstract

Section: Statistical Analysis Planmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Observational study investigating Tolerance Of Anticancer Systemic Therapy In the Elderly (TOASTIE): a protocol

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Rockwood and colleagues have operationalised the measurement of frailty using a clinical index consisting of deficits across various domains of functioning, such as disabilities, diseases, physical and cognitive impairments, and psychosocial factors. 8,9 This multidimensional nature of frailty makes it a global and better indicator of at-risk older patients than chronological age, 10 comorbidities 11 or performance scores 12 alone. Several clinical factors that determine higher frailty levels are also seen in myelofibrosis.…”

Section: Introductionmentioning

confidence: 99%

Association of frailty with clinical outcomes in myelofibrosis: a retrospective cohort study

et al. 2021

View full text Add to dashboard Cite

There is limited understanding of the impact of frailty on clinical outcomes in patients with myelofibrosis (MF). In this retrospective cohort study on 439 chronic phase MF patients [mean age: 68Á7 AE 12 years; median followup: 3Á4 years (IQR 0Á4-8Á6)] from 2004 till 2018, we used a 35-variable frailty index (FI) to categorise patient's frailty status as fit (FI < 0Á2, reference), prefrail (FI 0Á2-0Á29) or frail (FI ≥ 0Á3). The association of frailty with overall survival (OS) and cumulative JAK inhibitor (JAKi) therapy failure was measured using hazard ratio (HR, 95% CI). In multivariable analysis, prefrail (HR 1Á7, 1Á1-2Á5) and frail patients (HR 2Á9, 1Á6-5Á5), those with higher DIPSS score (HR 2Á5, 1Á6-3Á9) and transfusion dependency (HR 1Á9, 1Á3-2Á9) had shorter OS. In a subset analysis of patients on JAKi treatment (n = 222), frail patients (HR 2Á5, 1Á1-5Á7), patients with higher DIPSS score (HR 1Á7, 1Á0-3Á1) and transfusion dependence (HR 1Á7, 1Á1-2Á7) had higher cumulative incidence of JAKi failure. Age, comorbidities, ECOG performance status, and MPN driver mutations did not impact outcomes. Thus, higher frailty scores are associated with worse OS and increased JAKi failure in MF, and is a superior indicator of fitness in comparison to age, comorbidities, and performance status.

show abstract

“…The Rockwood Clinical Frailty Scale [4] (CFS) is a global assessment of fitness which has extensive evidence of correlation with outcome in a range of acute and outpatient settings, and has been adopted for use by the NHS Specialised Clinical Frailty Network (SCFN) in the United Kingdom (UK) [5]. It has also been proposed as an alternative to ECOG PS [6,7] but remains largely untested in the oncology setting.…”

Section: Introductionmentioning

confidence: 99%

Frailty and treatment outcome in advanced gastro-oesophageal cancer: an exploratory analysis of the GO2 trial

Pearce¹,

Swinson²,

Cairns³

et al. 2021

Journal of Geriatric Oncology

View full text Add to dashboard Cite

Introduction: Research into the optimal management of frail patients with cancer is limited and treatment decision-making in this cohort can be difficult. A number of measures have been developed to assess frailty, but few studies explore the correlation between frailty measures and cancer treatment outcomes. Methods: This retrospective cohort study is an exploratory analysis of the GO2 randomised controlled trial. GO2 recruited both older and frail younger patients commencing first-line palliative chemotherapy for advanced gastro-oesophageal (aGO) cancer. This analysis aims to explore the correlation between baseline frailty and treatment outcome. Baseline frailty measures were derived from clinical data and included ECOG Performance Status (PS), the GO2 Frailty Score (GO2FS), Geriatric-8 (G8), Cancer and Aging Research Group (CARG) toxicity score and a 'modified' Rockwood Clinical Frailty Scale (mCFS). Novel patient-centred composite measure Overall Treatment Utility (OTU) was the primary endpoint. Ordinal logistic regression was undertaken to give odds ratios for poor vs good/intermediate OTU. Secondary endpoints were progression-free and overall survival. Models were adjusted for age, sex, histology, metastases, Trastuzumab and renal/hepatic function. Results: In GO2, 514 patients were randomised between three chemotherapy dose-levels; all of these patients were assessed for OTU and are included in this analysis. Worse GO2FS, mCFS and G8 scores all had a statistically significant association with poor (vs good/intermediate) OTU, progression and death, which persisted after adjustment. Adjusted odds ratios for poor OTU amongst those with the worst GO2FS and mCFS and best G8 scores were as follows: 1.85 (95% confidence interval [CI] 1.20-2.88) for GO2FS ≥3 ('severely frail'), 1.72 (1.19-2.50) for mCFS 5+ ('frail') and 0.57 (0.32-1.00) for G8 > 14 ('normal'). Worse ECOG PS and CARG scores did not have a statistically significant association with poor OTU/progression/death. Conclusion: In this study, frailty identified via GO2FS, mCFS and G8 conveyed a statistically significant increased risk of worse treatment outcome in older and frail younger patients with aGO cancer. Frailty assessment provides information over and above PS and should be integrated alongside routine assessments in research and clinical practice. In the absence of prospective data, frailty measures can be derived retrospectively to build the evidence base around optimal care of frailer patients.

show abstract

The Rockwood Geriatric Clinical Frailty Scale is a more discriminatory tool for assessing older cancer patients compared with standard oncology performance status scales

Cited by 8 publications

References 0 publications

Observational study investigating Tolerance Of Anticancer Systemic Therapy In the Elderly (TOASTIE): a protocol

Observational study investigating Tolerance Of Anticancer Systemic Therapy In the Elderly (TOASTIE): a protocol

Association of frailty with clinical outcomes in myelofibrosis: a retrospective cohort study

Frailty and treatment outcome in advanced gastro-oesophageal cancer: an exploratory analysis of the GO2 trial

Contact Info

Product

Resources

About