Evaluation of Surgeon Attitudes Toward Frailty Screening in Breast Oncology Patients

The American Society of Clinical Oncology recommends integration of geriatric-specific screening tools in the evaluation of older adults undergoing systemic therapy. How these data affect surgical oncology care is underexplored. We evaluated the effect of these data on preoperative surgical decision-making and communication.

Patients ≥ 70 years, who presented to a breast surgical oncology clinic from October 2021 to May 2024 were screened for frailty using the Geriatric-8 (G8) and limited life expectancy using the Schonberg Index. Surgeons received the results prior to consultation with the patient. Post-visit surveys assessed whether the tools influenced treatment decisions or conversations. Semistructured interviews were conducted pre- and postimplementation to capture surgeon perspectives. Survey data were analyzed descriptively; interviews were analyzed by using a thematic analysis approach.

Thirteen surgeons participated; 92% were fellowship-trained. Among 233 patient encounters, results altered treatment plans a minority of the time (G8: 4%, Schonberg Index: 4%). However, approximately 30% of surgeons stated the results shifted discussion, and 10% discussed results explicitly with patients. Three themes emerged in interviews: (1) the tools often reinforced providers' subjective assessments and were most valuable in "borderline" cases; (2) surgeons desired better language to discuss frailty and life expectancy; and (3) structural factors affect tool utilization.

Routine frailty and limited life expectancy screening in an academic breast surgery clinic infrequently altered clinical management but did have the potential to inform conversations regarding tailoring locoregional therapy in older adults. Continued work on supporting surgeons in the integration of these tools into treatment conversations, and disseminating similar efforts in different clinical environments, is needed.