Utility of the Edmonton Frail Scale in identifying frail elderly patients during treatment of colorectal cancer.

BACKGROUND: Frailty has been proposed by geriatricians as an indicator of functional age. The Edmonton Frail Scale (EFS) is a 15-point incremental scale; it is quick (<5 min), and simple to administer. We conducted an exploratory study to establish if the EFS add utility to clinician's expertise by determining if there was an association between EFS and receipt of chemotherapy in colorectal cancer (CRC) patients. METHODS: The EFS was administered to stage II-IV CRC patients ≥70 years. EFS assessment was completed by one of the investigators, with the treating oncology team blinded to the results. RESULTS: A total of 46 patients were enrolled, and the EFS was reproduced in 32 patients at two visits (r=0.81; 95% CI: 0.64-0.90, P<0.0001). There was no correlation between the EFS and receipt of chemotherapy for the study population as a whole; however, exclusion of stage II patients showed a reduced likelihood of receiving chemotherapy with higher EFS scores (odds ratio 0.56; 95% CI: 0.37-0.85, P<0.01 per unit increment). A similar effect was observed after multivariable analysis (adjusting for performance status, age, stage and gender, odds ratio 0.41 95% CI: 0.18-0.96, P<0.05 per unit increment). CONCLUSIONS: This exploratory study suggests that EFS can identify patients that oncologists may have thought were too frail for chemotherapy, independent of PS. Therefore, the EFS has the potential to add a reproducible, and quantifiable measure of frailty to the clinician's decision making toolset. A follow up study will employ the EFS in real-time, and determine if using the EFS can minimize complications and unplanned health care utilization in elderly cancer patients.

Association between anemia arising during therapy and outcomes of chemoradiation for limited small-cell lung cancer.

BACKGROUND: Anemia during chemoradiation is associated with poorer outcomes in various cancers. Concurrent chemoradiation (CCRT) is standard therapy for fit patients with limited small-cell lung cancer (LD-SCLC). The objective of this study was to explore the relationship between anemia and treatment outcomes in patients with LD-SCLC treated with CCRT. METHODS: Charts of all patients with LD-SCLC receiving CCRT at The Ottawa Hospital Regional Cancer Centre between January 1996 and December 2002 were reviewed. Information extracted included demographics, known prognostic factors, treatment details, and hemoglobin values from diagnosis until the completion of therapy. Factors associated with outcomes were determined by Cox regression analyses. RESULTS: One hundred thirty patients were eligible for inclusion, and their median survival was 18.1 months (95% CI, 14.8-25.1 months). By univariate analysis, poorer outcome was associated with Eastern Cooperative Oncology Group performance status > or =2, supraclavicular adenopathy, and pre-radiotherapy hemoglobin <100 g/liter. Pre-radiotherapy hemoglobin <100 g/liter was associated with both an increased risk of progression (hazard ratio 1.8; P = 0.04) and death (hazard ratio 1.9; P = 0.02) by multivariate analysis. CONCLUSION: Anemia during CCRT for LD-SCLC is common and may be associated with poorer outcome. Whether this association is causative or simply prognostic is unclear, and it is not known whether correction or prevention of anemia will improve outcome. Clinical trials evaluating different target hemoglobin levels and the roles of transfusion or erythropoietin during CCRT are needed.