{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:20:07Z","timestamp":1792804807495,"version":"4.5.0"},"reference-count":48,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2020,5,5]],"date-time":"2020-05-05T00:00:00Z","timestamp":1588636800000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024396","name":"Healthcare Quality Improvement Partnership","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100024396","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,3,31]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Studies that use national datasets to evaluate the management of older women with breast cancer are often constrained by a lack of information on patient fitness. This study constructed a frailty index for use with secondary care administrative records and evaluated its ability to improve models of treatment patterns and overall survival in women with breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women aged \u226550 years with oestrogen receptor (ER) positive early invasive breast cancer diagnosed between 2014 and 2017 in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The secondary care administrative records frailty (SCARF) index was based on the cumulative deficit model of frailty, using International Statistical Classification of Diseases, Injuries and Causes of Death, 10th revision codes to define a set of deficits. The index was applied to administrative records that were linked to national cancer registry datasets. The ability of the SCARF index to improve the performance of regression models to explain observed variation in the rate of surgery and overall survival was evaluated using Harrell\u2019s c-statistic and decision curve analysis. External validation was performed on a dataset of similar women diagnosed in Wales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The SCARF index captured 32 deficits that cover functional impairment, geriatric syndromes, problems with nutrition, cognition and mood, and medical comorbidities. In the English dataset (n=67 925), the prevalence of frailty in women aged 50\u201369, 70\u201379 and \u226580 years was 15%, 28% and 47%, respectively. Adding a frailty measure to regression models containing age, tumour characteristics and comorbidity improved their ability to: (1) discriminate between whether a woman was likely to have surgery and (2) predict overall survival. Similar results were obtained when the models were applied to the Welsh cohort (n=4 230).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The SCARF index provides a simple and consistent method to identify frailty in population level data and could help describe differences in breast cancer treatments and outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-035395","type":"journal-article","created":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T06:36:50Z","timestamp":1588747010000},"page":"e035395","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":50,"title":["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"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4761-8655","authenticated-orcid":false,"given":"Yasmin","family":"Jauhari","sequence":"first","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa Ruth","family":"Gannon","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK"},{"name":"Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Dodwell","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, Oxford University, Oxford, Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Horgan","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, St James's University Hospital, Leeds, W Yorks, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Clements","sequence":"additional","affiliation":[{"name":"National Cancer Registration and Analysis Service, Public Health England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jibby","family":"Medina","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Tsang","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thompson","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, Leicestershire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Shuk-Kay","family":"Tang","sequence":"additional","affiliation":[{"name":"St George's University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Pettengell","sequence":"additional","affiliation":[{"name":"St George's University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Cromwell","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK"},{"name":"Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,5]]},"reference":[{"key":"2025121408360767000_10.5.e035395.1","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1016\/j.ejso.2014.06.001","article-title":"A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: failure to operate for early breast cancer in older women","volume":"40","author":"Bates","year":"2014","journal-title":"Eur J Surg Oncol"},{"key":"2025121408360767000_10.5.e035395.2","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.ejso.2015.12.012","article-title":"The use of surgery in the treatment of ER+ early stage breast cancer in England: variation by time, age and patient characteristics","volume":"42","author":"Richards","year":"2016","journal-title":"Eur J Surg Oncol"},{"key":"2025121408360767000_10.5.e035395.3","unstructured":"Healthcare Quality Improvement Partnership (HQIP) . 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