Frailty scoring in the management of people with skin cancer

Skin cancer incidence is rising in the UK, and with an increasingly aging population, so is frailty. Frailty scoring is not routinely utilised in skin cancer multi-disciplinary team decisions but may have the potential to enhance and personalise clinical management. The aim of this narrative review is to evaluate the literature on clinical tools used to assess frailty, guide management of people with skin cancer (melanoma and keratinocyte cancer) and identify the best frailty score to be used in skin cancer multi-disciplinary team management decisions in the UK. A literature search was conducted using MEDLINE and the results were screened for relevance to the clinical question. From the literature, we identified 12 different scoring tools studied in the management of skin cancer, across 15 papers, which we sub-categorised into 'comorbidity' and 'frailty' assessment tools. Of these, the Geriatric-8, Charlson Comorbidity Index and Adult Comorbidity Evaluation-27 were identified to be the most effective at identifying and stratifying frailty. However, the Rockwood Clinical Frailty Score is currently recommended by the British Geriatric Society and British Association of Dermatology. Notwithstanding the limitations of this critical appraisal (small cohort sizes, single-centre bias and overlapping or similar patient populations) we conclude that frailty scoring should be used in skin cancer multi-disciplinary teams so that patient related factors and tumour related factors are considered when managing skin cancer in older patients. Frailty scoring helps identify patients with limited life-expectancy and greater risk of complications, who may not benefit from 'gold-standard' treatments.

Abstract from PubMed