Assessment of older patients with cancer: Edmonton Frail Scale (EFS) as a predictor of adverse outcomes in older patients undergoing radiotherapy

Abstract Objective In this study we evaluate the usefulness of the Edmonton Frail Scale (EFS) in predicting which older patients are at risk of developing serious toxicities during radiotherapy. Materials and Methods This prospective study was carried out over an 18 month period. Our primary aim was to examine the Edmonton Frail Scale (EFS) as a predictor of toxicity in patients over 70 years undergoing radical radiotherapy for any malignant diagnosis. Results 63 patients were recruited: 29% experienced grade 3 or greater toxicities, with very few having multiple grade 3 or greater toxicities. The majority of patients experienced multiple grade 1 or 2 toxicities. Patients were often admitted: either electively due to geographical reasons, or due to toxicities. All patients completed their courses of radiotherapy. All grade 3 or 4 toxicities occurred within five radiotherapy sites; upper GI, gynaecological, lung, prostate and head & neck. There was no statistical correlation between EFS score and the presence of grade 3 or 4 toxicities. Conclusion This study showed that neither EFS score, age nor ECOG performance status were predictive of radiotherapy toxicity, breaks in treatment or hospital admissions. Patients with oesophageal cancer, gynaecological cancers and lung cancer had a high rate of toxicity and hospital admission, which may highlight the need for additional patient support in these groups. Whilst comprehensive geriatric assessment is recommended, further research is needed to conclude if the frail elderly patient is at greater risk of toxicities from radiotherapy, and which geriatric assessment tool may be the most helpful.