Does frailty influence treatment intent in men with non-metastatic prostate cancer?
Connors, K. Vickers, A. Conroy, Ruth Coyle, Catherine Hudson, Andrew M Logue, John P. Serra, Maria Tran, Anna T Mistry, Hitesh Wylie, James P
Connors, K.
Vickers, A.
Conroy, Ruth
Coyle, Catherine
Hudson, Andrew M
Logue, John P.
Serra, Maria
Tran, Anna T
Mistry, Hitesh
Wylie, James P
Citations
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Abstract
Purpose or Objective
Prostate cancer (PCa) is the most common cancer affecting men in the UK, with 35% of cases being diagnosed
in those 75 or over. Given the typically elderly cohort of patients, the degree of comorbidity and frailty is
high, which may influence treatment decisions. With the introduction of Clinical Frailty Scale (CFS) as part of
routine new patient assessment in addition to ECOG performance status (PS) and ACE-27 comorbidity score,
this study aims to assess the correlation between different measure of frailty and comorbidity, and clinician
treatment intent.
Materials and Methods
This is a prospective study of all non-metastatic PCa referrals to a tertiary oncology centre from July to August
2020. Demographic and clinical data were collected. Frailty and comorbidity status were assessed with 3
scoring systems – CFS, PS and ACE-27 comorbidity score. Scores were compared to the clinician documented
treatment intent using logistic regression analysis. We assessed for correlation between the three measures of
frailty and probability of receiving curative intent with univariable logistic regression analysis with R v3.6.0.
Results
Data was collected for 113 patients with a median age of 70 (48-84). All patients had documented PS and ACE27. 77 patients had documented PS, ACE-27 and CFS scores. PS 2 patients were less likely to be offered
curative treatment versus those with PS 0 (OR 0.02; 95%CI 0.01-0.64 p=0.02). PS 1 patients were as likely as PS
0 patients to be offered curative treatment (OR 1.00; 95% CI 0.01-NR; p=0.997). There was no correlation
between either ACE-27 or CFS with intent of treatment offered Conclusion
Randomised controlled trials show that frailty scores are useful for chemotherapy decisions compared to
known prognostic factors and are associated with treatment toxicity. This study shows that men with PS ≥2 are
less likely to be offered treatment with curative intent while CFS and ACE-27 did not appear to impact
treatment decisions. While the impact of PS on treatment plan is expected, the lack of correlation with CFS
and ACE-27 is interesting. The difference in influence of PS and CFS on clinician treatment decision may
reflect a lack of familiarity with CFS. Future work will evaluate this finding in a larger cohort of men, with a
particular interest in its impact on treatment related toxicities. This study is the first to assess utility of all 3
scores in men having prostate radiotherapy. Data collection continues and further analyses of associations
between PS, CFS and ACE-27 and their impact within a multivariable analysis with known prognostic factors is
required to establish the importance of these assessments when making treatment decisions.
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Connors K, Vickers A, Conroy R, Coyle C, Hudson A, Logue J, et al. Does frailty influence treatment intent in men with non-metastatic prostate cancer? Radiotherapy and Oncology. 2021;161:S1098-S.