{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T02:01:17Z","timestamp":1780365677688,"version":"3.54.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009128","name":"DH | NIHR | Research for Patient Benefit Programme","doi-asserted-by":"publisher","award":["NIHR200517"],"award-info":[{"award-number":["NIHR200517"]}],"id":[{"id":"10.13039\/501100009128","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Br J Cancer"],"published-print":{"date-parts":[[2026,6,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Frail patients with cancer (Ca) have worse survival. Current methods of assessment of fitness (performance status) for cancer treatment, such as chemotherapy, are time -consuming and often not used by practicing oncologists. The electronic frailty index (SCARF) is derived from a cumulative deficit frailty model and provides a measure of frailty alongside pre-existing conditions. We used this methodology to investigate whether it can predict outcomes of chemotherapy in patients with Ca.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study conducted data analysis of Ca patients treated with chemotherapy in England, years 2015\u20132018; stage II\u2013III breast Ca, stage III colon Ca and stage IIIB\u2013IV non-small-cell lung Ca. The data was linked with hospital admissions to calculate 30-day chemotherapy mortality, overall survival and SCARF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The SCARF was calculated for 78,799 patients. The risk of dying within 30 days of chemotherapy in severely frail patients with colorectal cancer \u226570\u2009y.o. was twice that of the &lt;70\u2009y.o. (OR 2.04 \u221295% CI 1.58\u20132.64, mild frailty 1.07\u201395% CI 0.78\u20131.45); and 6 times higher in breast cancer (OR 5.73\u201395% CI 2.66\u201312.32, mild frailty OR 1.45 95% CI 0.78\u20132.71).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The SCARF index predicts poor outcomes from SACT, particularly in breast and colon cancer, and it requires further evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41416-026-03389-y","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:07:16Z","timestamp":1775815636000},"page":"1793-1800","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The utility of electronic frailty index in cancer patients undergoing chemotherapy"],"prefix":"10.1038","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7262-6227","authenticated-orcid":false,"given":"Agnieszka","family":"Michael","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie","family":"Huynh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Sutton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man-Chie","family":"Chow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Ford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6229-3051","authenticated-orcid":false,"given":"Janine","family":"Mansi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Selby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7828-3122","authenticated-orcid":false,"given":"Simon","family":"Skene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Armes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"3389_CR1","unstructured":"National Audit of Breast Cancer in Older Patients website: NABCOP; 2018. URL NABCOP-2018-Annual-Report PDF (www.rcseng.ac.uk)."},{"key":"3389_CR2","unstructured":"National Confidential Enquiry into Patient Outcome and Death :Systemic Anti-Cancer Therapy: For better, for worse? (2008) URL https:\/\/www.ncepod.org.uk\/2008sact.html."},{"key":"3389_CR3","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1038\/bjc.1993.140","volume":"67","author":"JB Sorensen","year":"1993","unstructured":"Sorensen JB, Klee M, Palshof T, Hansen HH. Performance status assessment in cancer patients. An inter-observer variability study. Br J Cancer. 1993;67:773\u20135.","journal-title":"Br J Cancer"},{"key":"3389_CR4","doi-asserted-by":"publisher","first-page":"1936","DOI":"10.1038\/bjc.2013.204","volume":"108","author":"T Kalsi","year":"2013","unstructured":"Kalsi T, Payne S, Brodie H, Mansi J, Wang Y, Harari D. Are the UK oncology trainees adequately informed about the needs of older people with cancer?. Br J Cancer. 2013;108:1936\u201341.","journal-title":"Br J Cancer"},{"key":"3389_CR5","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1186\/s12877-024-05607-9","volume":"24","author":"S He","year":"2024","unstructured":"He S, Shepherd HL, Agar M, Shaw J. The value and effectiveness of geriatric assessments for older adults with cancer: an umbrella review. BMC Geriatr. 2024;24:1001.","journal-title":"BMC Geriatr"},{"key":"3389_CR6","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1093\/annonc\/mdu540","volume":"26","author":"C Handforth","year":"2015","unstructured":"Handforth C, Clegg A, Young C, Simpkins S, Seymour MT, Selby PJ, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2015;26:1091\u2013101.","journal-title":"Ann Oncol"},{"key":"3389_CR7","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1093\/annonc\/mdu210","volume":"26","author":"L Decoster","year":"2015","unstructured":"Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. dagger Ann Oncol. 2015;26:288\u2013300.","journal-title":"dagger Ann Oncol"},{"key":"3389_CR8","unstructured":"Karnofsky DA, Burchenal JH. The Clinical Evaluation of Chemotherapeutic Agents in Cancer. In: MacLeod CM, editor. Evaluation of Chemotherapeutic Agents, Columbia University Press, New York, 1949, p.196."},{"key":"3389_CR9","doi-asserted-by":"crossref","unstructured":"Carmichael JA, Wing-San Mak D, O\u2019Brien M. A review of recent advances in the treatment of elderly and poor performance NSCLC. Cancers. 2018;10:236.","DOI":"10.3390\/cancers10070236"},{"key":"3389_CR10","doi-asserted-by":"publisher","first-page":"83","DOI":"10.21037\/apm.2016.03.02","volume":"5","author":"R Chow","year":"2016","unstructured":"Chow R, Chiu N, Bruera E, Krishnan M, Chiu L, Lam H, et al. Inter-rater reliability in performance status assessment among health care professionals: a systematic review. Ann Palliat Med. 2016;5:83\u201392.","journal-title":"Ann Palliat Med"},{"key":"3389_CR11","doi-asserted-by":"publisher","first-page":"913","DOI":"10.3332\/ecancer.2019.913","volume":"13","author":"SS Datta","year":"2019","unstructured":"Datta SS, Ghosal N, Daruvala R, Chakraborty S, Shrimali RK, van Zanten C, et al. How do clinicians rate patient\u2019s performance status using the ECOG performance scale? A mixed-methods exploration of variability in decision-making in oncology. Ecancermedicalscience. 2019;13:913.","journal-title":"Ecancermedicalscience"},{"key":"3389_CR12","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.ejim.2018.06.012","volume":"56","author":"A Zucchelli","year":"2018","unstructured":"Zucchelli A, Vetrano DL, Marengoni A, Grande G, Romanelli G, Calderon-Larranaga A, et al. Frailty predicts short-term survival even in older adults without multimorbidity. Eur J Intern Med. 2018;56:53\u20136.","journal-title":"Eur J Intern Med"},{"key":"3389_CR13","doi-asserted-by":"crossref","unstructured":"Clegg A, Bates C, Young J, Ryan R, Nichols L, Teale EA, et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016;45:353\u201360.","DOI":"10.1093\/ageing\/afw039"},{"key":"3389_CR14","doi-asserted-by":"crossref","unstructured":"Birch R, Taylor J, Rahman T, Audisio R, Pilleron S, Quirke P, et al. A comparison of frailty measures in population-based data for patients with colorectal cancer. Age Ageing. 2024;53:afae105.","DOI":"10.1093\/ageing\/afae105"},{"key":"3389_CR15","doi-asserted-by":"publisher","first-page":"e035395","DOI":"10.1136\/bmjopen-2019-035395","volume":"10","author":"Y Jauhari","year":"2020","unstructured":"Jauhari Y, Gannon MR, Dodwell D, Horgan K, Clements K, Medina J, et al. Construction of the secondary care administrative records frailty (SCARF) index and validation on older women with operable invasive breast cancer in England and Wales: a cohort study. BMJ Open. 2020;10:e035395.","journal-title":"BMJ Open"},{"key":"3389_CR16","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.ejca.2014.11.011","volume":"51","author":"L Khoja","year":"2015","unstructured":"Khoja L, McGurk A, O\u2019Hara C, Chow S, Hasan J. Mortality within 30 days following systemic anti-cancer therapy, a review of all cases over a 4 year period in a tertiary cancer centre. Eur J Cancer. 2015;51:233\u201340.","journal-title":"Eur J Cancer"},{"key":"3389_CR17","volume":"2025","author":"K Sutton","year":"2025","unstructured":"Sutton K, Armes J, Skene SS, Mansi J, Michael A. The perceptions of patients, carers and clinicians relating to SACT decision-making in older people with cancer: qualitative findings from the electronic frailty index (eFI) in cancer study. Eur J Cancer Care. 2025;2025:4399728.","journal-title":"Eur J Cancer Care"},{"key":"3389_CR18","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ije\/dyz076","volume":"49","author":"KE Henson","year":"2020","unstructured":"Henson KE, Elliss-Brookes L, Coupland VH, Payne E, Vernon S, Rous B, et al. Data resource profile: national cancer registration dataset in England. Int J Epidemiol. 2020;49:16\u2013h.","journal-title":"Int J Epidemiol"},{"key":"3389_CR19","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1093\/ije\/dyz137","volume":"49","author":"CJ Bright","year":"2020","unstructured":"Bright CJ, Lawton S, Benson S, Bomb M, Dodwell D, Henson KE, et al. Data resource profile: the systemic anti-cancer therapy (SACT) dataset. Int J Epidemiol. 2020;49:15\u2013l.","journal-title":"Int J Epidemiol"},{"key":"3389_CR20","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/aje\/kwq433","volume":"173","author":"H Quan","year":"2011","unstructured":"Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676\u201382.","journal-title":"Am J Epidemiol"},{"key":"3389_CR21","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1200\/JCO.1984.2.3.187","volume":"2","author":"CC Schag","year":"1984","unstructured":"Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol. 1984;2:187\u201393.","journal-title":"J Clin Oncol"},{"key":"3389_CR22","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1200\/JOP.18.00180","volume":"14","author":"SG Mohile","year":"2018","unstructured":"Mohile SG, Dale W, Somerfield MR, Hurria A. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology summary. J Oncol Pr. 2018;14:442\u20136.","journal-title":"J Oncol Pr"}],"container-title":["British Journal of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41416-026-03389-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41416-026-03389-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41416-026-03389-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T01:01:58Z","timestamp":1780362118000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41416-026-03389-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":22,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2026,6,20]]}},"alternative-id":["3389"],"URL":"https:\/\/doi.org\/10.1038\/s41416-026-03389-y","relation":{},"ISSN":["0007-0920","1532-1827"],"issn-type":[{"value":"0007-0920","type":"print"},{"value":"1532-1827","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]},"assertion":[{"value":"28 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests. The corresponding author received grant funding as well as educational grants from the following: EUSA Pharma, GSK, Ipsen, MERCK, MSD.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study was approved by the Wales Research Ethics Committee 6 on 1 December 2020, REC reference: [\n                      \n                      ] \/WA\/0284; IRAS project ID: 279324; The study was approved by Public Health England Office for Data Release ODR1819_308. Consent from participants was sought for qualitative study, published, reference: Sutton K, Armes J, Skene SS, et al. The Perceptions of Patients, Carers and Clinicians Relating to SACT Decision-Making in Older People With Cancer: Qualitative Findings From the Electronic Frailty Index (eFI) in Cancer Study.\n                      European Journal of Cancer\n                      . The released data from PHE was de-identified and individual patient consent was not required. The study was performed in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}