Fitness assessment for older patients in breast clinic
Due to the range in general health amongst older women across the UK, it is important to accurately assess how comorbidity, functional status and cognition differ between patients, as these can affect treatment allocation for breast cancer. Clinical guidelines1,2 emphasise that treatment decisions should be based on clinical need and fitness rather than age alone. Decisions based solely on a woman’s age can lead to non-standard treatment of breast cancer in the elderly population.
In order to support clinicians in these decision making processes, the NABCOP has developed a ‘Fitness Assessment Form’ as a pragmatic tool to standardise how frailty and cognition are measured in breast clinics. The form was designed after multi-professional discussion including geriatricians, breast surgeons, oncologists, anaesthetists and patients, to be a valuable adjunct at the first diagnostic MDT and help guide the best course of treatment. It was successfully piloted across 11 NHS Trusts in December 2018, the results of which are described in the NABCOP 2019 Annual Report3.
The results of the fitness tool will be collected electronically as part of the updated Cancer Outcomes and Services Dataset (COSD) from 2020.
Contents of the assessment form
The form has three parts that record different aspects of health:
- The Clinical Frailty Scale, a common measure of frailty.
- The Abbreviated Mental Test Score (AMTS). This is a short series of questions to measure cognitive ability.
- Three questions about whether a patient has any major diseases e.g. cardio-respiratory disease.
The form will typically take less than 5 minutes to complete. We consider the assessment findings will be helpful at the diagnostic MDT and are readily available within the patient’s medical records. Users may augment the form as required to reflect your local population’s health care needs.
Patients who fulfil the following criteria are eligible to complete the fitness assessment form:
- aged 70 and over,
- attending breast clinic for the first time for suspicion of breast cancer.
When should the fitness assessment be used?
Any patient who fulfils the eligibility criteria who is attending breast clinic in an NHS hospital for the first time for suspicion of breast cancer (e.g. prior to any breast cancer diagnosis). We suggest the results should be available for the initial multi-disciplinary discussion where treatment plans are often influenced by estimation of patient fitness.
If you are a health care professional and would like some further information, click the link below for our staff information leaflet.
Questions or feedback
NABCOP are continuing to evaluate the practicality and utility of this assessment form. Please contact the project team at firstname.lastname@example.org or on 020 7869 6139 with any feedback or questions you may have. Alternatively, we are collecting feedback using an online survey that can be accessed using the below link (this should take 5-10 minutes to complete):
- Biganzoli et al. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). The Lancet Oncology Apr;13(4):e148-60.
- Cardoso et al. ESMO Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 30: 1194–1220.
- National Audit of Breast Cancer in Older Patients. 2019 Annual Report.
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