High prevalence of frailty identified with G8, compared with clinical frailty scale, in older patients with suspected lung cancer

Comprehensive Geriatric Assessment (CGA) is recommended in frail older patients with cancer, to enhance overall health during cancer treatment. Frailty in older patients with cancer increases risk of poor treatment outcomes. The “Geriatric-8 Questionnaire” (G8) is developed to identify frail patients, with cancer, in need of CGA, preferable assessed prior to treatment decision. Interest in the Clinical Frailty Scale (CFS) has recently increased, but its usability in geriatric oncology remains unclear. The primary aim of this study was to compare results of G8 and CFS screening tools among older patients suspected for lung cancer. Patients age ≥ 70 years, undergoing investigation for lung cancer, were screened for frailty using G8 and CFS. Frailty screening took place at Copenhagen University Hospital, Herlev & Gentofte Hospital, from February to August 2024. Frail (G8 ≤ 14 or CFS ≥ 5) and pre-frail (CFS = 4) patients were offered referral to CGA. Of 232 screened patients (median age: 77 years, 48% female), 145 patients (63%) were frail according to G8 (G8 ≤ 14) and 40 patients (17%) were frail according to CFS (CFS ≥ 5). Also, 54 patients (23%) were pre-frail (CFS = 4). Patients with a CFS score of 3 had a median G8 score of 14.3 (interquartile range (IQR): 13–15), and patients with a CFS score of 5 had a median G8 score of 11.0 (IQR: 10–13). Pre-frailty (CFS = 4) corresponded to a median G8 score of 12.0 (IQR: 9–14). Geriatric referral was accepted by 58 patients (37%). A substantial portion of patients were frail or pre-frail according to either one or both screening tools. Our findings suggest a CFS cut-off of 4, instead of 5, to better correspond with frailty according to the G8 questionnaire, in older patients with suspected lung cancer.