Dr Buckingham on the Use of Patient-reported Outcomes to Predict Frailty in Patients With Ovarian Cancer

Lindsey K. Buckingham, MD, fellow, gynecologic oncology, Department of Obstetrics and Gynecology, University of North Carolina (UNC) Chapel Hill School of Medicine, discusses an investigation into the use of patient-reported outcomes from the cancer-specific Geriatric Assessment (GA) to predict frailty in women with ovarian cancer, as well as planning the next steps for this research in other gynecologic cancers.

Although frailty measures are necessary to reduce surgical morbidity and chemotherapy toxicity in patients with gynecologic cancers, there is no standard instrument for predicting frailty in this population. The cancer-specific GA is a promising option that combines patient-reported outcomes (PROs) and practitioner-assessed measurements to provide a functional assessment of patients, Buckingham states. Data from the GA can be used to generate a Carolina Frailty Index (CFI) score, which then designates patients as frail, pre-frail, or robust, Buckingham explains.

A retrospective cohort study was designed to validate the use of the cancer-specific GA-generated CFI score to measure frailty in patients with ovarian cancer, Buckingham details. Researchers then attempted to investigate whether PRO measures from the GA alone could effectively predict frailty in this population, she adds.

Patients with ovarian cancer were selected using a single-institutional registry database based at UNC Chapel Hill's Lineberger Comprehensive Cancer Center, Buckingham continues. Enrolled patients were required to complete the GA, and prospective data on their cancer status, treatment, and survival were collected. CFI scores were calculated twice using the full-length GA vs the patient-reported outcome portion. Kaplan-Meier curves, median survival and 5-year survival probability was calculated, and survival comparisons were performed between patients according to frailty status.

Results showed that both the full-length GA and PRO portion of the GA were valid and were able to effectively predict patient survival according to frailty status, Buckingham states.

Based on these findings, the modified GA survey is being applied in a new, multicenter study of patients with ovarian and endometrial cancer, Buckingham says. The study will measure patient outcomes according to frailty status, as well as the feasibility of providing practitioners with this information ahead of treatment, she expands. Knowledge of a patient's ability to undergo surgery, tolerate chemotherapy, and response to specific doses could greatly improve upfront selection, Buckingham notes. Additionally, the adoption of such PRO measurements in clinical practice could help center patient experiences in treatment decision-making, Buckingham concludes.