EHR-Derived Frailty Linked to Hospitalization and Survival During Chemotherapy

Researchers evaluated 509 consecutive patients aged 65 years or older who received chemotherapy for newly diagnosed lung, colorectal, or breast cancer between 2017 and 2020. They calculated an electronic frailty index (eFI) from records covering at least two visits in the preceding two years, using clinical and functional measures. Patients were classified as fit, pre-frail, frail, or non-calculable; outcomes included hospitalization and overall survival.

Six-month hospitalization rates rose across the fit, pre-frail, and frail groups: 24%, 42%, and 62%, respectively. The rate was 50% among patients with a non-calculable score. Median overall survival was 38 months for fit patients, 23 months for pre-frail patients, 17 months for frail patients, and 10 months for the non-calculable group. Compared with fit patients, adjusted mortality risk was higher for pre-frail patients (HR 1.7, 95% CI 1.2–2.3), frail patients (HR 2.0, 95% CI 1.3–3.1), and those with non-calculable scores (HR 2.6, 95% CI 1.7–4.0).

The findings show an association between EHR-derived frailty and outcomes in this cohort, and suggest the approach could help identify patients at higher risk. The study does not show that eFI-guided care reduces hospitalization or improves survival; the non-calculable group also had poor outcomes, underscoring that missing data may itself warrant attention.