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Support Care Cancer. 2019 Apr;27(4):1535-1540. doi: 10.1007/s00520-018-4547-9. Epub 2018 Nov 14.

Frailty assessment prior to thoracic surgery for lung or esophageal cancer: a feasibility study.

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Department of Surgery, University of Toronto, 149 College St, Toronto, ON, M5T 1P5, Canada.
Section of Thoracic Surgery, Health Sciences Center, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.
Department of Medical Imaging, Princess Margaret Hospital, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G1J6, Canada.
Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G1J6, Canada.
Toronto General Hospital, 200 Elizabeth St., 9N-955, Toronto, ON, M5G 2C4, Canada.



Frailty assessment has not been thoroughly assessed in thoracic surgery. Our primary objective was to assess the feasibility of comprehensive frailty testing prior to lung and esophageal surgery for cancer. The secondary objective was to assess the utility of frailty indices in risk assessment prior to thoracic surgery.


Prospectively recruited patients completed multiple physiotherapy tests (6-min walk, gait speed, hand-grip strength), risk stratification (Charlson Comorbidity Index, Revised Cardiac Risk Index, Modified Frailty Index), and quality of life questionnaires. Lean psoas area was also assessed by a radiologist using positron emission tomography/computed tomography scans. Data was analyzed using Fisher's exact, Mann-Whitney U and independent t tests.


The feasibility of comprehensive frailty assessment was assessed over a 4-month period among 40 patients (esophagus n = 20; lung n = 20). Risk stratification questionnaires administered in clinic had 100% completion rates. Physiotherapy testing required a trained physiotherapist and an additional visit to the pre-admission clinic; these tests proved difficult to coordinate and had lower completion rates (63-75%). Although most measures were not significantly associated with occurrence of complications, the Modified Frailty Index approached statistical significance (p = 0.06).


Frailty assessment is feasible in the pre-operative outpatient setting and had a high degree of acceptance among surgeons and patients. Of the risk stratification questionnaires, the Modified Frailty Index may be useful in predicting outcomes as per this feasibility study. Pre-operative frailty assessment can identify vulnerable oncology patients to aid in treatment planning with the goal of optimizing clinical outcomes and resource allocation.


Esophageal neoplasms; Frailty; Lung neoplasms; Thoracic surgery

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