CN14 - The utility of a brief clinical frailty scale (CFS) in predicting prognosis and discharge destination in oncology inpatients

Background

Frailty is common in patients with cancer, and can predict outcomes and responses to treatment. Both cancer related symptoms and the impact of treatment can lead to increasing frailty in this population. The Rockwood CFS is a rapid tool which was originally designed in the 65+ population to assess underlying physiology and chances of functional improvement when older patients are admitted to hospital. When cancer patients are admitted to hospital it can be difficult to assess their fitness, using standard tools such as performance status. The utility of the CFS in cancer inpatients and whether it can be used in patients <65 years is unknown.

Methods

Clinical Frailty Score was measured as in Rockwood et al (PMID:16129869). The score of 9 (terminal illness) was removed due to concern that a number of patients will be scored in this manner reducing the potential utility. Patients were eligible if they were an inpatient at Newcastle upon Tyne Hospitals NHS trust; had a diagnosis of either solid tumour or haematological malignancy and had involvement from the Allied Health Professional Team. Data captured included age, diagnosis, number of medications, place of discharge and survival.

Results

237 patients had an assessment from 01/01/2019 to 01/04/2020. 151 patients have died, with a median follow-up of 190 days. Age ranged from 21 to 92 (median 67); 100 patients were <65. CFS significantly predicted survival (P<0.0001) as outlined in the table and the association was maintained in the group <65. Patients with a CFS score <5 had an 86% chance of getting home with appropriate support compared to 58% if CFS >6 (Odds ratio 4.6 (95% CI 2.3 to 9.3): P<0.0001). Table: 14CN

Conclusions

Routine assessment of CFS can be easily implemented onto oncology inpatient wards, with high levels of frailty seen. High CFS was associated with poor prognosis, and this included the <65 age group. CFS may help in discussions with patients and families as to prognosis, treatment escalation and planning for discharge.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.