Consistent, Standardized Frailty Assessments Could Improve Patient Outcomes

It’s not unusual for patients with hematologic malignancies who are candidates for hematopoietic stem cell transplantation (HSCT) to be frail, given that they’ve already undergone intensive therapy or multiple therapies to treat their cancer. But their healthcare providers may find it challenging to choose an assessment tool to determine just how frail they really are.

A team of researchers affiliated with the Virginia Commonwealth University School of Nursing hoped to learn more about the various frailty assessment tools in use. They analyzed 24 studies and learned that a variety of tools are in use, with many variations in how they define and measure frailty and apply it to decision-making. Their findings were published in Oncology Nursing Forum.

As with age, frailty can play a big role in how well a patient responds to treatment. But the lack of standardization of existing frailty assessment tools may hinder the treatment planning process, as well as the ability for clinicians to predict their patient’s likely prognosis.

The researchers noted that the CHS frailty index was the tool used most commonly across the studies they analyzed. This tool distinguishes between two frailty phenotypes, pre-frail and frail, by analyzing fatigue, decreased physical activity, slowed gait, decreased grip strength, and weight loss.

But the researchers suggested that a combination of frailty assessment tool, such as the CHS frailty index, with another assessment, such as a comorbidity index, may be more effective at predicting a patient’s prognosis.  

“Research has repeatedly shown the benefits of combining assessment tools for frailty and comorbidity to help improve healthcare providers’ ability to stratify high-risk patients, which also improves patient outcomes, such as overall survival,” they wrote.

At present, the specific tools (or combination of tools) have yet to be determined, but the researchers note that identifying a method that clinicians will then agree to use in a consistent manner should lead to the “implementation of appropriate interventions in a timely manner that will help to improve and sustain a better quality of life in these patient populations,” they wrote.

The researchers also noted that nurses are well-suited to conduct frailty assessments. They can also be involved in treatment planning and incorporating the frailty assessments results into the personalized care that they provide to patients with hematologic malignancies or patients undergoing HSCT.

Disclosure: This research was supported by the Virginia Commonwealth University Presidential Research Quest Fund. Please see the original reference for a full list of disclosures.

Reference

Mohanraj L, Sergent L, Brown R, Swift-Scanlan T. Frailty in patients with hematologic malignancies and those undergoing transplantation: a scoping review. Oncol Nurs Forum. 2021;48(3):291-307. doi:10.1188/21.ONF.291-307