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


Year:

Session type:

Mary Denholm1,Pippa Corrie2,Wendi Qian3,Joanna Hampton4
1Cambridge University Hospitals NHS Foundation Trust,2Department of Oncology, Cambridge University Hospitals NHS Foundation Trust,3Cambridge Cancer Trials Centre, Cambridge Clinical Trials Unit,4Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust

Abstract

Background

The ECOG and Karnofsky performance status (PS) scales are routinely used to assess cancer patients for treatment and disease monitoring, but are problematic to use in older people. The Rockwood clinical frailty scale (CFS) is established in geriatric medicine as a quick and easy 9 point frailty scale and has been shown to predict for mortality as well as inpatient length of stay. It has not been evaluated in a cancer setting. We sought to compare the use of CFS with ECOG and Karnofsky PS to assess cancer patients attending routine outpatient clinics.

Method

Doctors seeing patients in pancreaticoobiliary and melanoma clinics in our institution were provided with access to the CFS, ECOG and Karnofsky PS on the electronic medical record system. Electronic data recorded by doctors at clinic visits was extracted and analysed for patients <70 or >70 years old.

Results

Between 1/7/2016 and 30/11/16, 114 patients had all 3 scales recorded at the same clinic visit 332 times. Age range was 22–88 (median 64) years. Based on the worst status recorded for an individual patient for each of the 3 scales, the distribution of ECOG PS scores did not differ between patients below and above 70 years (p=0.31), Karnofsky PS scores did differ (p=0.02), while CFS scores differed the most (p=0.0056). Concordances (weighted Kappa) between the 3 scales for patients <70 (n=78) and ≥70 (n=36) years were: 0.84 versus 0.49 comparing Karnofsky with ECOG PS; 0.63 versus 0.27 comparing ECOG PS with CFS; 0.76 versus 0.55 comparing Karnofsky PS with CFS.

Conclusion

The shortest scale, ECOG PS, performed worst in older people. This first assessment of the Rockwood CFS in a cancer population suggests it may be more discriminatory in older age groups than established oncology performance status scales, warranting further evaluation.