Different Frailty Measures Valued in Patients With CRC

The Hospital Frailty Risk Score, Secondary Care Administrative Records Frailty index, and the frailty syndromes measures were able to assess frailty in patients diagnosed with colorectal cancer (CRC).

Frailty can be quantified in patients with colorectal cancer (CRC) using different frailty tools, notably the Hospital Frailty Risk Score (HFRS), Secondary Care Administrative Records Frailty (SCARF) index, and the frailty syndromes (FS) measures. According to the study published in Age and Ageing,1 context and requirements of each individual epidemiology determine which measure is best to assess frailty.

Colorectal cancer | Image credit: Dr_Microbe -

Colorectal cancer | Image credit: Dr_Microbe -

CRC affects 43,000 people2 in the United Kingdom each year, with 268,000 individuals living with the cancer as of 2024. At least 40% were 75 years or older at diagnosis. Frailty describes how older adults decline in physiological systems, with risk of frailty increasing with older age. The contribution of frailty to the increased diagnosis at an older age is not well understood. Assessments for frailty have been developed and used for this purpose. This study aimed to compare the HFRS, the SCARF index, and the FS model through the use of a dataset from England.

Patients who were 18 years or older and diagnosed with CRC in England between 2016 and 2019 were the target participants of this study. The CRC data repository was used to collect linked cancer registration and Hospital Episode Statistics (HES), which is an English hospital discharge dataset. All data were collected from National Health Service (NHS) hospitals.

The 3 frailty measures used for the study were the HFRS, which was developed using the HES dataset and calculated using the score of more than 109 codes for each individual. The SCARF index was developed using a national cohort of women and was calculated as the total number of deficits divided by the total number of participants in the index, which equals 32 participants. The FS measure was developed with a national cohort of patients 65 years and older admitted to the emergency department. Patients were classified using the FS of anxiety and depression, cognitive impairment, functional dependence, falls and fractures, mobility problems, and pressure ulcers.

There were 136,008 participants who were diagnosed with CRC between 2016 and 2019 who were registered in the NHS; 26.7% died within a year of diagnosis. All measures were feasible to create. After quantifying frailty using diagnosis codes, 98.7% had a linked record in HES in the 2 years before their diagnosis and 54.2% had no indication of frailty.

Prevalence of frailty was different across all measures, with the HFRS measure finding a 3.8% prevalence of patients at high risk, the SCARF measure finding a 13.6% prevalence of patients with severe frailty, and the FS model finding a 2.1% prevalence of patients with 3 or more frailty syndromes. Patients who died within a year of diagnosis had a higher level of frailty across all 3 measures: 9.8% in the HFRS measure, 25.7% in the SCARF measure, and 5.6% in the FS measure compared with 1.7%, 9.2%, and 0.8% in the patients still alive at 1 year, respectively.

Frailty increased with age in each measure, with the HFRS measure finding 0.6% of those younger than 65 years were frail compared with 11.4% in those 85 years and older. This was the same in the SCARF measure, which increased from 3.3% in those younger than 65 years to 30.9% in those 85 years and older; the FS measure saw an increase of 0.4% among those younger than 65 years and 6.4% in those 85 years and older.

The overall survival across 1 year was similar across all 3 measures, at 78% (95% CI, 78%-78%) in the HFRS measure, 81% (95% CI, 80%-81%) in the SCARF measure, and 78% (95% CI, 78%-79%) in the FS measure in people who were classified as fit. The proportion of people who were classified as fit decreased overall between 2005 and 2019.

There were some limitations to this study. Quantifying frailty through diagnostic codes was a particular challenge, as patients who were not admitted in the time frame would not be considered frail. Also, condition severity was not collected in favor of noting whether the patient had the condition at all. Further, secondary care data were the only data used in the study, which could be a limitation, and there was no standard measure of frailty against which to compare these models.

The HFRS, SCARF, and FS measures can be a valuable tool in helping to quantify the inequities in patients with CRC that are age related. Future studies should evaluate the association between frailty and treatment use and outcomes in patients with CRC.


1. Birch R, Taylor J, Rahman T, et al. A comparison of frailty measures in population-based data for patients with colorectal cancer. Age Ageing. 2024;53(5):afae105. doi:10.1093/ageing/afae105

2. Bowel cancer. Bowel Cancer UK. Updated May 2024. Accessed May 28, 2024.

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