title: 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.
  
  
  METHODS
  This prospective study was carried out over an 18month period. Our primary aim was to examine the Edmonton Frail Scale (EFS) as a predictor of toxicity in patients over 70years 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: St Lukes Radiation Oncology Network, St Lukes Hospital, Rathgar, Dublin 6, Ireland. Electronic address: lornakeenan@gmail.com.
authors.forename: Lorna G
authors.initials: LG
authors.lastname: Keenan
authors.affiliation: St Lukes Radiation Oncology Network, St Lukes Hospital, Rathgar, Dublin 6, Ireland.
authors.forename: Michelle
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: St Lukes Radiation Oncology Network, St Lukes Hospital, Rathgar, Dublin 6, Ireland.
authors.forename: Tim
authors.initials: T
authors.lastname: Ryan
authors.affiliation: St Lukes Radiation Oncology Network, St Lukes Hospital, Rathgar, Dublin 6, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Dunne
authors.affiliation: St Lukes Radiation Oncology Network, St Lukes Hospital, Rathgar, Dublin 6, Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: McArdle
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D000073496:Frailty / Q000175:diagnosis*; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects
keywords: Frailty; Geriatric assessment; Radiation toxicity