Construction of the secondary care administrative records frailty (SCARF) index and validation on older women with operable invasive breast cancer in England and Wales: A cohort study

Yasmin Jauhari*, Melissa Ruth Gannon, David Dodwell, Kieran Horgan, Karen Baker, Jibby Medina, Carmen Tsang, Thompson Robinson, Sarah Shuk Kay Tang, Ruth Pettengell, David A. Cromwell

*Corresponding author for this work

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Abstract

Objectives: Studies that use national datasets to evaluate the management of older women with breast cancer are often constrained by a lack of information on patient fitness. This study constructed a frailty index for use with secondary care administrative records and evaluated its ability to improve models of treatment patterns and overall survival in women with breast cancer. 

Design: Retrospective cohort study. 

Participants: Women aged ≥50 years with oestrogen receptor (ER) positive early invasive breast cancer diagnosed between 2014 and 2017 in England. 

Methods: The secondary care administrative records frailty (SCARF) index was based on the cumulative deficit model of frailty, using International Statistical Classification of Diseases, Injuries and Causes of Death, 10th revision codes to define a set of deficits. The index was applied to administrative records that were linked to national cancer registry datasets. The ability of the SCARF index to improve the performance of regression models to explain observed variation in the rate of surgery and overall survival was evaluated using Harrell's c-statistic and decision curve analysis. External validation was performed on a dataset of similar women diagnosed in Wales. 

Results: The SCARF index captured 32 deficits that cover functional impairment, geriatric syndromes, problems with nutrition, cognition and mood, and medical comorbidities. In the English dataset (n=67 925), the prevalence of frailty in women aged 50-69, 70-79 and ≥80 years was 15%, 28% and 47%, respectively. Adding a frailty measure to regression models containing age, tumour characteristics and comorbidity improved their ability to: (1) discriminate between whether a woman was likely to have surgery and (2) predict overall survival. Similar results were obtained when the models were applied to the Welsh cohort (n=4 230). 

Conclusion: The SCARF index provides a simple and consistent method to identify frailty in population level data and could help describe differences in breast cancer treatments and outcomes.

Original languageEnglish
Article numbere035395
JournalBMJ Open
Volume10
Issue number5
DOIs
Publication statusPublished - 5 May 2020

Bibliographical note

Funding Information: This study was undertaken as part of the work by the National Audit of Breast Cancer in Older Patients. The Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme and funded by NHS England and the Welsh Government (www.hqip.org.uk/national-programmes). The authors had full independence from the Healthcare Quality Improvement Partnership. The aim of National Audit of Breast Cancer in Older Patients (NABCOP) is to evaluate the care of older women with breast cancer in England and Wales, and support NHS providers to improve the quality of hospital care for these women. More information can be found at: www.nabcop.org.uk

Open Access: http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Publisher Copyright: © Author(s) (or their employer(s)) 2020. Published by BMJ.

Citation: Jauhari Y, Gannon MR, Dodwell D, et al. Construction of the secondary care administrative records frailty (SCARF) index and validation on older women with operable invasive breast cancer in England and Wales: a cohort study. BMJ Open 2020;10:e035395.

DOI: 10.1136/bmjopen-2019-035395

Keywords

  • adult oncology
  • geriatric medicine
  • public health
  • statistics & research methods

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