DOI: 10.1177/10966218261476769 ISSN: 1096-6218

The Prognostic Value of the Clinical Frailty Scale Without Category 9 in Older Adults with Advanced Cancer

Wen Yang Goh, Allyn Yin Mei Hum
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Background:

The Clinical Frailty Scale (CFS) is widely used, but the “terminally ill” category 9—defined by a <6-month prognosis—may limit nuanced survival estimation in geriatric oncology.

Objective:

To evaluate the prognostic utility of the CFS when category 9 is omitted. Methods: This retrospective study analyzed 901 older adults (≥65 years) with incurable cancer at a palliative clinic. Patients were stratified into CFS 2–5 ( n = 618) and CFS 6–8 ( n = 283). Survival was assessed using multivariate Cox regression.

Results:

Median survival was significantly shorter for CFS 6–8 compared to CFS 2–5 (90 vs. 158 days; p < 0.001). For 3-month mortality, CFS 6–8 demonstrated a hazard ratio (HR) of 2.25 compared to CFS 2–5. After adjusting for age, symptoms, albumin, and comorbidities, the CFS remained an independent predictor of 3-month (HR 2.07) and 6-month mortality (HR 1.57).

Conclusion:

Omitting category 9 allows the CFS to provide meaningful prognostic data, facilitating better end-of-life planning in geriatric oncology.

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