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EFI an Objective, Standardized Approach Option to Frailty in Colorectal Cancer
Frailty is often linked to poor health outcomes in patients with cancer. Traditional frailty indices tend to be time consuming and are not widely utilized in clinical oncology. An Electronic Frailty Index (EFI) created from electronic medical records can be utilized as an objective, standardized approach to frailty in patients with colorectal cancer, according to Huili Zhu, MD (Baylor College of Medicine, Houston, TX).
At the 2022 ASCO Quality Care Symposium, Zhu presented “Electronic Frailty Index: A risk stratification tool for survival and health care outcomes in veterans with colorectal cancer,” to assess the association between EFI and health care utilization outcomes and survival in patients with colorectal cancer.
Using Veterans Affairs (VA) administrative files from 2016 to 2020, as well as the VA Central Cancer Registry, Zhu and colleagues were able to identify a group of 6,043 patients who had been diagnosed with colorectal cancer. An EFI was then calculated using a validated 31-item cumulative deficit frailty index that sought to identify three groups: robust (≤ 0.1), prefrail (0.1–0.2), and frail (> 0.2), and Cox proportional hazard analyses were conducted to evaluate survival. Logistic regression examined prolonged length of stay greater than or equal to the median (11 days) during all-cause hospitalization and emergency department visits within 1 year after diagnosis. Models were adjusted for age, gender, race, Charlson Comorbidity Index, and stage.
The EFI determined that 45.6% of the colorectal cancer patients were robust, 34.5% were prefrail, and 19.9% fell into the category of frail. The group consisted of both rectal cancer (22.9%) and colon cancer (77.1%) patients across all stages (Stage I, 29.2%; Stage II, 25.0%; Stage III, 25.2%; Stage IV, 20.6%). Compared to robust patients, there was an increased risk of death in prefrail patients (adjusted hazard ratio [aHR] 1.21; confidence interval [CI] 1.10–1.32) and frail (aHR 1.90; CI 1.71–2.11) patients.
Additionally, researchers found increased odds of 1-year emergency department visits among those in the prefrail (adjusted odds ratio [aOR] 1.18; CI 1.06–1.35) and frail (aOR, 1.66, CI 1.43–1.94) categories. Increased odds of 1-year hospitalization and prolonged length of stay were found among the prefrail (aOR 1.38; CI 1.11–1.70) and frail (aOR 1.79; 95% CI 1.39–2.30) groups.
Investigators determined that there was a significant link between survival and health care utilization. Patients who were determined to be frail had almost an 80% increased likelihood of prolonged hospitalization. According to Zhu and colleagues, EFI could be an automated and objective support tool at the point of care for risk assessment before CRC treatment-related stressors like surgery or chemotherapy, but more work is needed to develop an EFI that is specific to cancer in order to help guide treatment decisions and improve quality of care.
Source
Zhu H, Razjouyan J, Yarlagadda S, et al.. Electronic Frailty Index: A risk stratification tool for survival and health care outcomes in veterans with colorectal cancer. Presented at: the 2022 ASCO Quality Care Symposium; September 30- October 1, 2022; Chicago, IL, and virtual; Abstract 375.
