The Impact of Frailty Screening on Radiation Treatment Modification

SIMPLE SUMMARY: Most oncology patients today are ≥65 years, so we should include in our daily practice tools that facilitate the therapeutic approach for elderly patients. Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs). The aim of our prospective study was to analyze if frailty screening questionnaires, such as G8 or Charlson, could lead to rapid decision making about treatment change in a radiation oncology service. In a homogeneous population of 161 patients, with a median age of 75 years, we found that 28.7% were frail according to the G8 test, while the estimated survival at 10 years was 2.25% based on the Charlson test. The therapeutic modification increased to 21% after frailty analysis, and the radiotherapy prescribed was 5.8 times more likely to be modified in frail patients. Thus, we postulate that the frailty screening test, easier to integrate into clinical practice, is a reliable and efficient aid for optimal approach. ABSTRACT: Background: Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. Methods: Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. Results: Of 161 patients; 69.4% were male, the median age was 75 years (range 65–91), and the prevailing performance status (PS) was 0–1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. Conclusions: CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making.