Retrospective study of electronic health record embedded frailty index and outcomes among older adults receiving cancer chemotherapy

A retrospective study at Wake Forest University School of Medicine (Winston-Salem, NC) evaluated whether an automated electronic health record (EHR)-based frailty index (eFI) is associated with hospitalization and overall survival (OS) in older adults receiving chemotherapy for cancer. The authors identified 509 consecutive patients aged ≥ 65 years with newly diagnosed lung, colorectal, or breast cancer (2017-2020). An automated eFI score was calculated using data from at least 2 visits in the 2 years before chemotherapy, including vital signs, smoking status, diagnoses, selected laboratory values, and functional measures. Frailty was categorized using a cumulative deficit approach as fit (eFI ≤ 0.10), prefrail (0.10-0.21), or frail (> 0.21). Among 509 patients (median age 72.2 years), 27.7% were fit, 42.4% prefrail, 14.9% frail, and 14.9 had non-calculable eFI. Six-months hospitalization increased with frailty: 24% (fit), 42% (prefrail), 62% (frail), and 50% (non-calculable) (p<0.0001). Median OS was 38 months (fit), 23 months (prefrail), 17 months (frail) and 10 months (non-calculable) (p<0.0001). In adjusted models, mortality risk was higher in prefrail (HR 1.7; 95% CI 1.2-2.3), frail (2.0; 1.3-3.1), and non-calculable (2.6; 1.7-4.0) groups compared with fit patients. The authors conclude that HER-derived frailty was associated with hospitalization and survival, supporting the eFI as a scalable approach to risk stratification in older adults receiving chemotherapy.