• Lene Kirkhus, Šaltytė BenthJūratėJThe Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, PO box 68, Ottestad 2313, Norway.Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO box 4956 Nydalen, Oslo 0424, Norway.HØKH Research Centre, Siri Rostoft, Bjørn Henning Grønberg, Marianne J Hjermstad, Geir Selbæk, Torgeir B Wyller, Magnus Harneshaug, and Marit S Jordhøy.
• The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, PO box 68, Ottestad 2313, Norway.
• Br. J. Cancer. 2017 Aug 8; 117 (4): 470-477.

BackgroundFrailty is a syndrome associated with increased vulnerability and an important predictor of outcomes in older cancer patients. Systematic assessments to identify frailty are seldom applied, and oncologists' ability to identify frailty is scarcely investigated.MethodsWe compared oncologists' classification of frailty (onc-frail) based on clinical judgement with a modified geriatric assessment (mGA), and investigated associations between frailty and overall survival. Patients ⩾70 years referred for medical cancer treatment were eligible. mGA-frailty was defined as impairment in at least one of the following: daily activities, comorbidity, polypharmacy, physical function or at least one geriatric syndrome (cognitive impairment, depression, malnutrition, falls).ResultsThree hundred and seven patients were enroled, 288 (94%) completed the mGA, 286 (93%) were rated by oncologists. Median age was 77 years, 56% had metastases, 85% performance status (PS) 0-1. Overall, 104/286 (36%) were onc-frail and 140/288 (49%) mGA-frail, the agreement was fair (kappa value 0.30 (95% CI 0.19; 0.41)), and 67 mGA-frail patients who frequently had localised disease, good PS and received curative treatment, were missed by the oncologists. Only mGA-frailty was independently prognostic for survival (HR 1.61, 95% CI 1.14; 2.27; P=0.007).ConclusionsSystematic assessment of geriatric domains is needed to aid oncologists in identifying frail patients with poor survival.

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