Title: The role of Electronic Frailty Index in improving outcomes for newly diagnosed CAncer patients undergoing systemic Chemotherapy treatment
Funder: Department of Health and Social Care

Abstract: Older and frail patients with cancer are a group for whom it is acknowledged that potentially curative treatment rates often fall below that seen in other patient groups. There is evidence that older patients who are often fit receive less aggressive treatment and have worse survival. We also know that many frail patients often do not tolerate systemic chemotherapy well and are frequently harmed as a result of treatment. Current methods of assessment of fitness for intensive cancer treatment such as chemotherapy are inadequate. The recommend approach is a comprehensive geriatric assessment however its complexity, lack of appropriate training and time pressure in busy NHS clinics mean that better solutions are needed. The developments in the digital field and electronic sources of information give new opportunities and offer solutions that can be accessed at the point of referral from GPs and have a potential to change daily clinical practice. The electronic frailty index (eFI) has been derived from a cumulative deficit frailty model and provides a measure of frailty alongside pre-existing conditions. It takes into account 36 deficits that are common in general population such as arthritis, cardiac abnormalities, cognitive problems, polypharmacy and a number of other comorbidities. EFI is automatically populated from routinely collected data contained within the primary health care records. Patients can be classified into groups: no frailty, mild, moderate or severe frailty. The three frailty groups identify the risk of hospital admission as well as the likelihood of admission to the nursing home within one year. The current proposal seeks to assess the utility of the electronic frailty index (eFI) in patients who are referred for systemic chemotherapy for newly diagnosed cancer. We propose to conduct this research in two phases: the development phase (current proposal) and the validation phase that will follow in the future. The development phase will consist of historical data analysis from SACT (systemic anticancer chemotherapy ) dataset, GP electronic medical records and HES data (hospital episode statistics) alongside with a qualitative study to examine the views of patients, carers and clinicians to use an electronic score in daily clinical practice. The primary objective of this research project is to define the relationship between eFI and adverse outcomes of chemotherapy in frail patients with cancer as defined by 30-day chemotherapy mortality and hospital admissions. We have previously analysed the SACT data for patients treated in 2013-2015 with breast, lung and colorectal cancer and we plan to extend this analysis to include eFI derived from hospital records as well as GP electronic medical records and link it with 30-day chemotherapy mortality and hospital admissions during chemotherapy. The secondary objectives will define he acceptability of using eFI in assessing frailty in cancer patients, the suitability of the endpoints for a future definitive study and the overlap and accuracy between hospital derived eFI and GP database derived eFI. The long term plan is to validate the eFI as a tool that can be used in daily clinical practice and accurately predicts adverse outcomes of chemotherapy.

Lay abstract: Diagnosis of cancer is a fearful event for most people. It is a common occurrence and adequate information and provision of the best treatment can not be underestimated. The treatment of many cancers involves major interventions such as surgery, chemotherapy and radiotherapy. All of those can cause severe side effects and can be life changing. Treatment of people who are frail is even more challenging. Our health can be affected by cancer itself and a range of other conditions and it is really important that we balance the side effects of cancer treatment against the harms it can cause. We know from several studies that clinicians struggle with adequate assessment of older people living with frailty and with cancer and offer less aggressive treatment even if they are not frail. We also know that many frail and older patients suffer multiple side effects of treatment and sometimes die as a result of the treatment itself. This approach leads to older patients with cancer living shorter lives. We need an improved way of assessing frail patients with cancer. We believe it is possible to use a score that can be calculated from medical records that will help us to better estimate the risks of chemotherapy. This score is known as electronic frailty index and has been useful in general practice. Electronic frailty index is now automatically calculated by GPs from electronic medical records. To validate this type of score in cancer we need to undertake research project in 2 parts. The first part will look at the information we can obtain form historical chemotherapy records as well as GP databases. We also plan to interview patients, carers and clinical teams to make sure such approach is acceptable to them and that they would be prepared to use it in clinical practice. In part 2 of the project that will follow in the future we plan to run a large clinical trial and test the electronic frailty index in patients who are referred for chemotherapy treatment. We believe that it will give both patients and clinicians more information and help them make the right decision regarding cancer treatment. In the long term this project has the potential to improve lives of frail patients with cancer.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: CANCER AND NEOPLASMS