Reimagining Frailty Screenings in Head and Neck Cancer

Eden R. Brauer, PhD, RN

Frailty screenings are clinically feasible in head and neck cancer care and may be seamlessly incorporated into regular workflows, according to a poster presentation from the 2023 ASCO Quality Care Symposium.

“Frailty status predicts adverse outcomes—including poorer survival—in patients with cancer, but is rarely assessed in practice,” Eden R. Brauer, PhD, RN, assistant professor at the UCLA School of Nursing, wrote in the poster.

“Frailty screening is clinically feasible in routine care and provides a whole-person approach and valuable insights to treatment planning,” she added.

A New Approach

Frailty describes a complex medical syndrome where an individual has demonstrated a decline in their physiologic reserve and is more vulnerable to stressors that can complicate their treatment.

For this study, investigators aimed to find ways to implement frailty screening within the preexisting workflow, making frailty/malnutrition screenings part of the standard of care for those with head and neck cancer patients.

The new system was implemented between August 2020 and November 2022. Clinicians used the Risk Analysis Index (RAI) and the Malnutrition Screening Tool (MST) to determine the prevalence of frailty and malnutrition. Patients were evaluated at intake, and their results were presented at tumor board. After 21 months, an electronic survey was issued to clinicians to analyze the results and characterize their perceptions.

Overall, 83% (n = 488) of eligible patients were screened (n = 585). The mean age was 63.1 years. Sixty-four percent of patients were male, 78% were Non-Hispanic, 43% were employed, and 67% were married.

Patient Outcomes and Provider Perceptions

Among those who were screened, 43% were classified as non-frail, 53% were classified as frail, and 4% were classified as very frail. Additionally, 86% were classified as not at risk for malnutrition, while 14% were identified as malnourished.

Frailty, status was associated with survival in the study population, and patients who were frailer had poorer survival outcomes. The hazard ratio for survival was 2.94 (95% CI, 1.46-5.93; P < .005) in the frail population (n = 257) and was 5.70 (95% CI, 2.70-15.7; P < .005) in the very frail population (n = 21).

Ultimately, 79% of clinicians (n = 14) shared in a survey that they felt that these frailty screening should continue.

In addition, the clinician surveys showed that providers felt it was an effective way to provide holistic care.

Frailty screening tests are a “quick and efficient way to get information about the patient as a ‘whole person’–beyond just imaging,” wrote 1 respondent. Another respondent reflected that these tests offer a “valuable heads-up” regarding a patient’s vulnerability.

Similarly, providers felt that these tests offer clinically actionable screening results. Participants shared that they liked that the criteria triggered referrals to supportive care based on frailty scores and that this process helped ensure that patients didn’t get “lost in shuffle.”

Reference

Brauer E. Frailty screening in head and neck cancer care: Implementation outcomes and clinician perspectives. JCO Oncol Pract. 2023;19(suppl 11):453. 10.1200/OP.2023.19.11_suppl.453