Rapid assessment of frailty prior to treatment of elderly colorectal cancer patients.
Bibliographic record
Abstract
e20522 Background: Frailty is traditionally assessed by a comprehensive geriatric assessment (CGA); there is no agreed upon standard for a CGA, and it is not feasible to implement in routine oncology practice. In contrast, the Edmonton Frailty Scale (EFS) is a simple questionnaire, requiring less than 5 minutes to complete, initially validated as a surrogate to the CGA in general medicine patients (Rolfson et al, 2006). We conducted a pilot study to establish if the EFS would add utility beyond clinician’s expertise. Methods: The EFS was administered to stage II-IV CRC patients ≥70 years, referred to a Medical Oncologist at a tertiary care centre. The EFS was completed by one of the investigators, with the treating oncology team blinded to results, and follow up of 14 months. Results: Forty-six patients were enrolled with the following characteristics: average age 76, 48% male, and 78% Zubrod performance status (PS) 0-1. The EFS was reproducible between visits (r = 0.81 [95%CI 0.64-0.9], p<0.01). No association existed for the EFS and receipt of chemotherapy for the study population as a whole, however none of the stage II patients had features requiring chemotherapy. Restricting the analysis to stage III/IV patients demonstrated a reduced likelihood of receiving chemotherapy with higher EFS scores (Odds ratio 0.56 per unit increment [95%CI 0.37-0.85] p<0.01). A similar effect was observed after multivariate analysis (adjusting for PS, age, stage and gender, Odds ratio 0.41 per unit increment [95%CI 0.18-0.96] p<0.05). The clinician’s qualitative impression was associated with the EFS (p<0.01). No association existed between the EFS and upfront dose reductions, choice of less toxic regimens, or hospitalization secondary to grade 3/4 toxicities. Conclusions: The EFS can identify patients that Oncologists may have thought were too frail for chemotherapy, independent of PS. The EFS has the potential to add a reproducible, and quantifiable measure of frailty to aid in decision making in oncology practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".