Clinical frailty in advanced lung cancer patients: an opportunity to improve outcomes

Abstract

Introduction: Clinical frailty is associated with ageing and it may impact survival, quality of life, anti cancer treatment tolerability and access to clinical trials. The NHS Specialized Clinical Frailty Network is promoting frailty assessment and management in specialized centres. Methods: A quality improvement project was developed to implement a frailty pathway for lung cancer patients. The 1st part consisted on implementing a frailty screening, the Rockwood Clinical Frailty Scale (CFS). Primary aim: screen ≥80% of new lung cancer patients. Secondary aims: correlation of CFS with age, performance status (PS), cancer treatment selection and systemic anti-cancer treatment (SACT) tolerability. CFS 1-3 was defined as fit and 4-8 as frail. Analysis data cut-off: 06-10-2019. Results: 864 lung cancer patients (any age) were screened over 10 months using CSF integrated as an electronic form with a compliance rate of 89% within the main hospital site. 41% of patients with advanced lung cancer had some degree of frailty. Frailty correlated with ageing (r=0.2; p<0.01) and PS (r=0.77; p<0.01). Frailty reduced the relative risk of receiving any cancer treatment or the likelihood of continuing SACT beyond 1st cycle by 20%. Frail patients had a higher rate of admissions (p=0.04) and required more support from nursing team. Conclusion: The implementation of a frailty screening tool is feasible in a busy clinical practice when incorporated as a digital tool. CFS helps identifying patients who may potentially benefit from specialized frailty assessment and management. This may help informing treatment selection and support frail cancer patients during their treatments improving their outcomes.