Funder: NIHR Doctoral Research Fellowship (personal award holder: Jessica Pearce)
Background: With an ageing population, the number of older people living with cancer and frailty is increasing. Frailty is a term used to describe a person’s reduced ability to overcome stresses on the body, and cancer treatments such as chemotherapy can be one such stress. Chemotherapy can cause side-effects and complications which can impact on a persons’ quality-of-life. Patients with frailty are more likely to experience significant problems. With this in mind, weighing the benefits and risks, and making decisions about cancer treatment options can be particularly difficult for patients living with frailty and those who care for them. Frailty can be assessed (measured) with a number of tools, which could be used to help to guide cancer treatment decision-making. The ‘gold-standard’ (best tool available) for assessing frailty is the geriatric assessment. However, geriatric assessments generally require referral to a geriatric medicine specialist which can be time-consuming, burdensome for patients and costly. There are simpler tools which could be used to assess frailty within cancer care, but these are not used routinely.
Objective: To develop a FRAilty-informed cancer ManagEment (FRAME) intervention to support shared treatment decision-making for patients with advanced cancer
Study design: This fellowship will start by summarising existing research about the relationship between simple frailty assessments and cancer treatment outcomes. It will look in detail at how simple frailty assessments can be used within cancer care, with a key focus on how they can support shared cancer treatment decision-making between patients and healthcare professionals.
The UK Specialised Clinical Frailty Network (SCFN) has been testing the use of simple frailty assessments in cancer services through a number of pilots across the country since 2018. We will learn from their experiences by conducting interviews with patients/carers and staff at three pilot sites to find out: 1) whether frailty assessment is acceptable to them 2) how it is being used 3) what impact it is having on patient care.
We will then work with key stakeholders (patient representatives/carers/healthcare staff/researchers) to develop a ‘FRAilty-informed cancer ManagEment (FRAME) intervention, guided by earlier research findings. The intervention will aim to support shared treatment decision-making between patients with advanced cancer and those that care for them. Based on preparatory work, we anticipate the intervention will involve staff being trained on how to assess frailty better and how to improve discussions with patients when planning cancer treatments such as chemotherapy; alongside materials to support patient/carer information needs.
The intervention will be tested in clinic with a small group of patients and staff. Routinely collected data, questionnaires and interviews will find out: 1) if FRAME is acceptable to patients/staff 2) whether FRAME can be successfully used in day-to-day practice 3) how to conduct a larger future study to test whether it works.
Study team: This project is led by Dr Jessica Pearce, and co-supervised by Dr Alex Gilbert and Prof Galina Velikova from the Patient-Centred Outcomes Research (PCOR) group, as well as Prof Suzanne Richards and Prof Andrew) Clegg.