Background: It is increasingly recognized that frailty should be assessed and considered in treatment decision making in patients with cancer. This review and meta-analysis synthesizes existing evidence evaluating the association between baseline frailty and systemic anticancer treatment outcomes in adults with cancer. Methods: Five databases were systematically searched from database inception to January 2023 to identify prognostic factor studies (cohort or case-control design) reporting the associations between validated frailty assessments (pretreatment) and follow-up outcomes in adults with solid-organ malignancy undergoing systemic anticancer treatment. Risk of bias was assessed via Quality of Prognosis Studies in Systematic Reviews tool. Where appropriate, associations between frailty and outcomes (survival, toxicity, treatment tolerance, functional decline/quality of life, and hospitalization) were synthesized in meta-analysis and presented as forest plots. Results: A total of 58 studies met inclusion criteria. They were undertaken in a range of tumor sites and mainly in older patients and advanced and/or palliative disease settings. Most had low or moderate risk of bias. Nine frailty assessment tools were evaluated. Four outcomes were synthesized in meta-analysis, which demonstrated the prognostic value of 2 tools: Geriatric-8 (survival, treatment tolerance, hospitalization) and Vulnerable Elders Survey-13 (survival, toxicity, treatment tolerance). Overall pooled estimates indicate that frailty conveys an increased risk of mortality (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.41 to 2.00), toxicity (odds ratio [OR] 1.83, 95% CI = 1.24 to 2.68), treatment intolerance (OR = 1.68, 95% CI = 1.32 to 2.12), and hospitalization (OR = 1.94, 95% CI = 1.32 to 2.83). Conclusion: Simple, brief frailty assessments including Geriatric-8 and Vulnerable Elders Survey-13 are prognostic for a range of important outcomes in patients undergoing systemic anticancer treatment. Risk estimates should be used to support shared decision making.

Cancer is a disease associated with ageing. Managing cancer in older adults may prove challenging owing to pre-existing frailty, comorbidity, and wider holistic needs, as well as the unclear benefits and harms of standard treatment options. With the ongoing advances in oncology and the increasing complexity of treating older adults with cancer, the geriatric oncology field must be a priority for healthcare systems in education, research, and clinical practice. However, geriatric oncology is currently not formally taught in undergraduate education or postgraduate training programmes in the United Kingdom (UK). In this commentary, we outline the landscape of geriatric oncology undergraduate education and postgraduate training for UK doctors. We highlight current challenges and opportunities and provide practical recommendations for better preparing the medical workforce to meet the needs of the growing population of older adults with cancer. This includes key outcomes to be considered for inclusion within undergraduate and postgraduate curricula.

Introduction: The use of patient-reported outcomes (PROs) has been shown to enhance the accuracy of symptom collection and improve overall survival and quality of life. This is the first study comparing concordance and patient preference for two PRO tools: Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE^®) and the adapted-REQUITE Lung Questionnaire.Materials and Methods: Patients with lung cancer were recruited to the study while attending outpatient clinics at a tertiary cancer centre. Clinician-reported outcomes were generated through initial patient assessment with CTCAE v4.03. Participants then completed the PRO-CTCAE^® and adapted-REQUITE questionnaires. Concordance between the 2 questionnaires was assessed by calculating Pearson correlation coefficient. PRO-CTCAE^® and CTCAE concordance was demonstrated by calculating Pearson correlation coefficient from the linear predictors of an ordinal logistic regression. P-values were also calculated.Results: Out of 74 patients approached, 65 provided written informed consent to participate in the study. 63 (96.9%) patients completed both PRO-CTCAE^® and adapted-REQUITE questionnaires. Pearson correlation coefficient between PRO tools was 0.8-0.83 (p <.001). Correlation between CTCAE and PRO-CTCAE^® ranged between 0.66-0.82 (p <.001). Adapted-REQUITE and CTCAE correlation was higher for all symptoms ranging between 0.79-0.91 (p <.001). Acceptable discrepancies within one grade were present in 96.8%-100% of symptom domains for REQUITE and in 92.1%-96.8% for all domains in the PRO-CTCAE^®. 54% of the total participant cohort favored the adapted-REQUITE questionnaire due to reduced subjectivity in the questions and ease of use.Conclusion: The adapted-REQUITE questionnaire has shown a superior correlation to clinician-reported outcomes and higher patient preference than the PRO-CTCAE^®. The results of this study suggest the use of the REQUITE questionnaire for patients with lung cancer in routine clinical practice.

There is an unmet need in patient monitoring between the end of radiotherapy and the first follow-up appointment during which patients may experience severe side effects. Personalised follow-up has the potential to tailor healthcare to individual needs. ePROMs enable remote monitoring and identification of those needing earlier intervention. To assess the feasibility of integrating ePROMs into personalised follow-up of patients after radiotherapy. Patients with lung or head and neck (HN) cancer were enrolled. ePROMs questionnaires, comprising EQ-5D-5L and 14 lung or 19 HN cancer-specific questions adapted from CTCAE v5.0, were sent to patients at eight timepoints: pre-radiotherapy, mid-radiotherapy, end of radiotherapy, weekly for four weeks post-treatment, and first face-to-face follow-up appointment. Upon completion, automated advice was provided based on responses. Grade 2 or above symptoms were escalated to clinicians. Patient feedback was obtained through structured interviews. Over two months, 19 eligible patients (10 lung, 9 HN) were recruited: 13 received concurrent chemoradiotherapy, and six received radiotherapy alone. ePROMs completion rate was 69.1%, ranging from 47.4% to 89.5% at each timepoint. Three patients reported grade 3 or above symptoms on 5 instances during and after radiotherapy. Fourteen patients participated in the interviews: all 14 reported ePROMs were easy to complete, took an acceptable amount of time, and made them feel better supported. Integrating ePROMs into personalised follow-up is feasible and acceptable to patients. ePROMs provide insights into patients’ symptoms during and after radiotherapy, highlighting the need for a tailored approach.

Routine collection of electronic patient-reported outcome measures (ePROMs) enhances symptom monitoring and improves outcomes in cancer care. We evaluated published reports of real-world ePROM implementation in oncology, focusing on approaches to implementation, types of ePROMs used, completion rates, factors associated with ePROM completion, and impacts on patient and health care process/system-level outcomes. We also aimed to propose a classification of ePROM programmes. We systematically searched Medline, Embase, CINAHL Complete, and Scopus for articles describing routine ePROM implementation and evaluation. Data charting captured characteristics of the study, study population, characteristics of routinely collected ePROMs, and evaluation of their routine use. We also present a new classification of ePROM programmes into three levels: asynchronous, clinician-supervised, and real-time clinician-supervised, based on clinical pathway integration. Of 10 384 identified manuscripts, 50 met the inclusion criteria, reporting on 39 real-world ePROM programmes. Nearly all ePROM programmes (97.4%) collected data on symptom burden. The median overall completion rate was 61% (interquartile range 47%-76%), with substantial variability over time and across hospitals. Completion was associated with sociodemographic, clinical, and treatment-related factors. Most ePROM programmes (61.5%) were classified as asynchronous models, with five (12.8%) clinician-supervised models and three (7.7%) real-time clinician-supervised models, while seven (17.9%) lacked sufficient detail. The most frequently reported outcomes were fewer hospitalisations or emergency department visits (10.3%) at the patient level and improved symptom identification (17.9%) at the process/system level. ePROMs are increasingly embedded in routine oncology care, demonstrating benefits at both patient and system levels. However, most current programmes adapt asynchronous models with limited rapid clinician interaction.

ObjectivesThe routine use of electronic patient-reported outcome measures (ePROMs) in oncology is expanding internationally, yet uncertainty remains regarding the most suitable tool for routine care. The Christie Symptom Inventory-Lung Cancer (CSI-Lung) was developed for routine care. This study evaluated its content validity, psychometric performance using real-world data, and patient experience.Materials and MethodsA mixed-methods evaluation, guided by COSMIN methodology, was conducted. Content validity was assessed through cognitive interviews with nine patients, examining item relevance, comprehensibility, and comprehensiveness. Quantitative analyses used routinely collected ePROM data from 2,483 patients with lung cancer. Test-retest reliability was assessed using quadratic-weighted Cohen’s kappa, with stable health defined using EQ-5D-5L and EQ-VAS. Construct validity was evaluated using Spearman correlations with EQ-5D-5L (convergent validity) and comparisons across ECOG performance status (known-groups validity). Responsiveness was assessed using Kendall’s tau between symptom changes and EQ-VAS changes. Patients experience was evaluated through surveys completed by 274 patients.ResultsInterviews demonstrated high relevance and comprehensibility. Test-retest reliability showed weighted kappa > 0.7 for 8/14 items, with over 50% agreement across items. All items expectedly correlated negatively with EQ-5D-5L, particularly tiredness, pain, and breathlessness. Known-group validity was supported, with worse symptoms in patients with poorer performance status. Responsiveness analyses showed expected negative correlations with EQ-VAS. Patient experience was positive: 93% found CSI-Lung easy to complete, 92% clinically useful, and 89% supportive of care.ConclusionCSI-Lung demonstrated measurement properties consistent with clinical expectations and high patient acceptability, supporting its use in routine care and further validation across diverse settings and populations.