The association between an electronic health record (EHR)–embedded frailty index
and patient-reported outcomes among patients with metastatic non–small-cell lung cancer
on immunotherapy.
Authors: Nur Saadia , McLouth Laurie , Levine Beverly J. , Lycan Thomas William , Ruiz Jimmy , Farris Michael , Pajewski Nicholas , Weaver Kathryn E. , Petty William J. , Frechman Erica L , Callahan Kathryn E. , Klepin Heidi D. , Gabbard Jennifer 
Published: October 2024

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Background: While frailty is a well-established predictor of
overall mortality among patients with metastatic non-small cell lung cancer (mNSCLC),
its association with patient-reported outcomes is not well-characterized. We assessed
quality of life and symptom burden by frailty status among mNSCLC patients receiving
immunotherapy. We used an electronic health record (EHR) frailty index (eFI) as a marker
of frailty. In addition, we assessed self-perceived goals of treatment by frailty
status. Methods: In a cross-sectional study, patients from a
single academic medical center with mNSCLC who were on first or second-line
immunotherapy or chemoimmunotherapy completed the European Organization for the Research
and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) and the
National Cancer Institute Patient Reported Outcomes version of the Common Terminology
Criteria for Adverse Events (PRO-CTCAE). In addition completed the Prognosis Treatment
and Perceptions Questionnaire. We computed means of EORTC-QLQ-C30 subscales and
proportions reporting at least moderate PRO-CTCAE symptoms, and compared results across
three levels of frailty status using the eFI (which uses 54 variables from the EHR to
calculate a score from 0-1), which categorizes frailty status as either fit (eFI ≤0.10),
pre-frail (0.10 < eFI≤0.21), or frail (eFI > 0.21). P-values for comparisons of
continuous variables were derived from F-tests from ANOVA models, while those for
comparisons of categorical variables were derived from chi-square or Fisher’s exact
tests. Results: Sixty patients (mean age 62.5 years, 75%
Caucasian, 60% women, 57% receiving single-agent immunotherapy) participated. Most
patients were pre-frail (68%), with few categorized as fit (18%) or frail (n=15%). The
EORTC-QLQ-C30 global health score was similar among frailty categories (mean 62.6).
Among EORTC functional subscales, only physical function differed by frailty status
(mean 83.9 fit vs 74.8 pre-frail vs 60.0 frail, p-value 0.04). We found no differences
in any of the EORTC-QLQ-C30 symptom subscales across frailty categories. On the
PRO-CTCAE measures, only self-reported pain differed among the three groups, with pain
being higher among frail patients (75% of frail reporting at least moderate pain, vs
51.5% of pre-frail and 18.2% of fit; p=0.046). No differences in self-perceived goals of
treatment or likelihood of cure emerged by frailty status.
Conclusions: Frail patients identified by the eFI with mNSCLC
have higher rates of pain and physical functional impairments but similar perspectives
on likelihood of cure as those without frailty. This highlights the importance of
symptom monitoring and frailty screening along with prognostic discussions in those with
mNSCLC. Clinical trial
information: NCT03741868 .