Indicators of frailty in newly diagnosed lung cancer patients: A retrospective review.
Authors: Chauhan Meera , Dulloo Sean , Jaitly Jaya , Arif Zeeshan , Thomson Jamie , Sharma Sagar , Anees Ismail , Aleem Bushra , Vijay Anupama 
Published: June 2022

e24017

Background: Lung cancer is frequently diagnosed over the age of 70 years, in a population with increased risk factors for frailty. Frailty impacts cancer treatment selection, tolerance, and quality of life. We performed a retrospective study to determine whether there is a difference in the indicators of frailty in patients of different ages, and if this impacted treatment choice. Methods: Electronic records of patients who were discussed at the University Hospitals of Leicester Lung multidisciplinary team meeting (MDT) between January to December 2019 with a suspected diagnosis of lung cancer were reviewed. Populations below the age of 65 years and over the age of 65 years were compared. Results: 846 patient records were reviewed, and 80% were aged over 65 years. Baseline WHO performance status (PS) where recorded showed 35% were PS 0-1, and 28% were 3-4. Comparatively, in the under 65 population 46% were PS 0-1, and 10% were 3-4. The over 65s had a lower rate of independence with activities of daily living (ADLs) compared to the under 65s (54% vs 71%), assistance with basic ADLs was higher (10% vs 5%) and patients with unassisted mobility was also lower (48% vs 66%). The over 65s had an increased rate of multiple comorbidities compared to the younger group (no comorbidity 25% vs 30%, 3 or more comorbidities 27% vs 14% respectively.) Where curative intent was intended, in the under 65s, surgical review deemed 24% unsuitable and of these, 72% had a discussion regarding radiotherapy with 61% receiving treatment. Comparatively in the older population, 40% of patients were deemed unsuitable for surgery and 69% went for discussion regarding radiotherapy with 44% receiving treatment. Where systemic anti-cancer therapy (SACT) discussion was advised, more patients in the under 65 group saw a medical oncologist compared to the older group (73% vs 61%) and had a higher rate of subsequent SACT (80% vs 61%). There were similar rates of non-completion of SACT in the over 65s compared to the younger group (55% vs 54%) and number of dose reductions (18% vs 15%). 35% of the over 65s and 46% of the under 65s received immunotherapy. In the older population, 30% received monotherapy, compared to 17% in the younger population. 37% of the older patients having SACT were admitted with a median stay of 2 days (range 1-30) compared to 31% in the younger group, with a median stay of 1.5 days (range 1-2). Conclusions: Our review demonstrates that in the older population, PS is higher, with a lower independence rate for ADLs, a higher level of assisted mobility and increased comorbidity. These frailty indicators impacted treatment options; less older patients were suitable for treatment compared to the younger population. The older population displayed more indicators of frailty potentially impacting treatment options, and this highlights the need for active frailty assessment and rapid intervention in the lung cancer population to allow a full range of treatment options.