Doctor’s judgement falls short for assessing frailty in elderly cancer patients

The physician’s clinical judgement is insufficient for the assessment of frailty among elderly cancer patients, and should be complemented with more structured tools, such as the geriatric assessment (GA), a recent study has found

The study included 55 cancer patients (aged ≥70 years; 40 percent female) who were just initiating curative or first-line palliative chemotherapy. Physicians were asked to judge patient frailty using a rating scale that ranged from 0–10, with 10 indicating frailty. Participants were also evaluated using the GA, which included the mood, polypharmacy, mobility, nutrition, and instrumental activities of daily living (IADL) domains.

The GA saw a high prevalence of geriatric impairments. For example, 75 percent were at risk of malnutrition and 60 percent had impaired IADL. Overall, each participant showed a median of two impairments, though 49 percent had three or more impairments.

In contrast, clinical assessors deemed that the patients were relatively fit, and the resulting median frailty score for all three assessors was 3. There was a weak and positive correlation between the assessors, but for individual patients, the variations between each judge’s scores were large.

In turn, the associations between clinical judgement scores and GA findings were also weak and positive, such that as the number of GA impairments increased, the assessors also tended to assign higher rating scale values. However, clinical judgement remained too conservative. Patients with ≥3 impaired domains would still get scored <5 on the clinical frailty rating scale.

“[O]ther frailty assessments, such as frailty screening tools or GA, should be considered in addition to clinical judgment when selecting older patients with cancer for potential treatment with chemotherapy,” researchers said.