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.2018.01.575

Cited by 7 publications

(5 citation statements)

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“…17 Our study used the Clinical Frailty score as the frailty assessment tool. The Clinical Frailty score is well validated, [18][19][20][21][22] with Clinical Frailty score, the Frailty Index and the Frailty Phenotype the most commonly used frailty tools. 23 A systematic review looking at screening of frail patients in the ED found only four studies meeting the inclusion criteria and concluded that more randomised clinical trials of frailty screening tools compared to usual care are clearly needed.…”

Section: Discussionmentioning

confidence: 99%

Patients with life‐limiting illness presenting to the emergency department

Ragg

Milnes

et al. 2019

Emerg Medicine Australasia

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Objective To examine characteristics, outcomes and flow for patients over the age of 45 years with a life‐limiting illness (LLI) presenting to a regional ED. Methods Retrospective, observational cohort study of patients with LLI in an Australian regional ED over a 15‐day period. Eligible patients were 45 years of age or older who fulfilled criteria for having an LLI. Data included demographics, diagnosis for current presentation, presence of advance care documentation, LLI category, admission and discharge destination from ED, ED and hospital length of stay and outcome for patients admitted to the acute hospital. Results A total of 152 (12%) patients had an LLI. The LLI group were older, had a significantly longer median length of stay in the ED (5.9 [interquartile range 4.0–8.4] vs 3.9 h [interquartile range 2.5–6.3], P < 0.0001) and were less likely to leave the ED within 4 h (26% vs 51.5%, P < 0.0001). Forty‐six percent of patients with an LLI had some form of advanced care documentation. Patients with an LLI were more likely to require hospital admission. In relation to illness trajectory, the frailty/dementia trajectory group had comparatively the longest ED length of stay with less than 10% leaving the ED within 4 h. This group were more likely to be discharged to a residential care facility. Conclusion A significant proportion of patients 45 years or older had an LLI which had implications for their length of ED stay and discharge destination.

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Section: Discussionmentioning

confidence: 99%

Patients with life‐limiting illness presenting to the emergency department

Ragg

Milnes

et al. 2019

Emerg Medicine Australasia

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“…A total of 114 cancer patients were assessed using these three clinical tools. The CFS was the best tool at differentiating patients below and above 70 years (p = 0.0056) followed by the Karnofsky (p = 0.02), whereas the ECOG performance status found no differences [17].…”

Section: Cambridgementioning

confidence: 94%

The care of older cancer patients in the United Kingdom

Gomes¹,

Lewis²,

Morris³

et al. 2020

ecancer

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The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under-and over-treatment. Therefore, the assessment of a patient's biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one's fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific Review

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“…Performance status, measured by the Eastern Cooperative Oncology Group (ECOG) or Karnofsky performance status measures, attempts to capture the functional status of the person with cancer, and is widely used in treatment decision making in radiation oncology. However, it is subjective, and does not reflect the full extent of vulnerability among older adults with cancer [22] , [23] . Therefore, other more objective assessments are required.…”

Section: What Is Frailty?mentioning

confidence: 99%

“…Its evaluation, thus far, in those who have cancer, is limited to one small surgical series of patients with pancreaticobiliary and melanoma cancers. In this study, the CFS was deemed to have greater discriminatory power than the more commonly used ECOG performance status [23] . A validation study in community-dwelling older people demonstrated that it was a better predictor of mortality than simple measures of cognition, function or comorbidity [33] .…”

Section: How Do We Assess Frailty?mentioning

confidence: 99%

Personalised treatment for older adults with cancer: The role of frailty assessment

O’Donovan

Leech

2020

Technical Innovations & Patient Support in Radiation Oncolo

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It is widely accepted in clinical practice that chronological age is a poor predictor of treatment tolerance and outcomes in older adults with cancer. Intrinsic vulnerability is more a function of underlying frailty, rather than chronological age. Frailty is a state of increased vulnerability to stressors, such as cancer and its treatment, which can lead to adverse health outcomes for patients. Capturing this heterogeneity in reserve capacity is the cornerstone of management in geriatricmedicine, but remains poorly understood or adopted in radiation oncology. A two-step approach, using a shorter screening tool, followed by full assessment for those who need it, is the mostresourceful way of implementing frailty assessment in radiotherapy departments. It is important for radiation oncology professionals to identify frailty and to use this information in multidisciplinary decision making in order to develop a personalised radiotherapy approach for the older person. There are many ways we can effectively use this information, such as considering treatment fractionation schedules that would limit the burden of travel for those with social frailty, or reviewing the range of modalities at our disposal, which might limit toxicity in the older person at high risk of deterioration during treatment. Frailty assessment is not carried out in many radiotherapy departments presently, but there are many international models to use as exemplars as to how it may be implemented in clinical practice. There are many opportunities for further research and role development in this field at the current time.

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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 7 publications

References 0 publications

Patients with life‐limiting illness presenting to the emergency department

Patients with life‐limiting illness presenting to the emergency department

The care of older cancer patients in the United Kingdom

Personalised treatment for older adults with cancer: The role of frailty assessment

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