Frailty screening in head and neck cancer care: Implementation outcomes and clinician perspectives.

Authors

null

Eden Brauer

University of California, Los Angeles, Los Angeles, CA

Eden Brauer, Stephanie Lazaro, Andrew Erman, David Rapkin, Jennifer Jeong, Vijaya Surampudi, Elliot Abemayor, Deborah J.L. Wong, Maie St. John

Organizations

University of California, Los Angeles, Los Angeles, CA, UCLA School of Nursing, Los Angeles, CA, UCLA, Los Angeles, CA, Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, UCLA Medical Center, Los Angeles, CA

Research Funding

No funding received
None.

Background: Frailty is a complex medical syndrome characterized by an increased vulnerability to stressors, distinct from age or comorbidity. Among patients with head and neck cancers, frailty is a significant predictor of post-operative complications, reduced quality of life, and increased rates of morbidity and mortality. Despite these known risks, frailty status is rarely assessed in routine oncology care or considered systematically in treatment planning. In this study, we evaluated the implementation of a frailty screening protocol as a new standard of care for patients with head and neck cancers at a large academic medical center. Methods: Frailty screening was embedded into an existing telephone-based intake workflow for newly referred patients, using the patient-reported Risk Analysis Index (RAI). RAI data was scored, documented in the health record, and presented at weekly case conferences. To evaluate the implementation, medical record data, including frailty status and sociodemographic and clinical information, between August 2020 and November 2022 was abstracted, and feedback from clinicians was collected using a brief survey on perceived clinical value. For the chart review and clinician survey, quantitative data was analyzed using descriptive statistics; thematic analysis was used to identify key findings in the qualitative data. Results: During the evaluation period, 488 of 585 eligible patients completed the frailty screening questionnaire, resulting in a compliance rate of 83.4%. Of those screened, the mean age was 63.1 years (SD: 16.2), 64% were male, and 20.5% had > 3 comorbid conditions. For the total sample, the mean RAI score was 38.4 (SD: 6.52), with 43% deemed not frail, 52.7% frail, and 4.3% very frail. For the survey, the majority of respondents (11/14) believed that frailty screening added clinical value. Key qualitative themes emphasized how frailty screening facilitated a “whole patient” approach and a “valuable heads-up regarding a patient’s vulnerability.” Potential enhancements focused on making RAI data more clinically actionable. Conclusions: Overall, findings suggest that frailty is common in patients with head and neck cancer, and that frailty screening is achievable in routine care and provides clinical value to multidisciplinary oncology teams at the time of treatment planning. Future work may extend these findings to inform targeted pre-habilitation interventions for frail HNC patients and examine their impact on clinical outcomes.

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Abstract Details

Meeting

2023 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Quality, Safety, and Implementation Science,Cost, Value, and Policy,Patient Experience,Survivorship

Sub Track

Quality Improvement Research and Implementation Science

Citation

JCO Oncol Pract 19, 2023 (suppl 11; abstr 453)

DOI

10.1200/OP.2023.19.11_suppl.453

Abstract #

453

Poster Bd #

K11

Abstract Disclosures

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