Validation of the Taiwan Cancer Frailty Tool for Screening and Prognosis in Non-older Patients With Cancer: A...

IntroductionFrailty is a known predictor of poor outcomes in older patients with cancer; however, its recognition in non-older populations remains limited. In this prospective multicenter observational study, we compared the Taiwan Cancer Frailty Tool (TCFT) with the Flemish version of the Triage Risk Screening Tool (fTRST) and comprehensive geriatric assessment (CGA) in screening for frailty among non-older Taiwanese patients with cancer.MethodsWe prospectively enrolled 1,162 patients with cancer aged <65 years from multiple Taiwanese centers (2022-2024). Frailty was assessed using CGA (reference standard), TCFT, and fTRST, with frailty defined as ≥2 abnormal CGA domains. Both TCFT and fTRST were tested at two thresholds (>0 and >1). Diagnostic performance metrics and Kaplan-Meier survival analyses were performed.ResultsThe median patient age was 54 years (range, 20-64 years), and 74.6% were male. The predominant cancer types were head and neck, esophageal, and gastric/small bowel cancers. The prevalence of frailty was 44.0% (CGA), 65.0% (TCFT >0), and 73.4% (fTRST >0). TCFT >0 demonstrated a higher sensitivity (88.8%) and negative predictive value (86.0%) than fTRST >0 (88.5% and 80.9%, respectively). TCFT >1 provided superior specificity (93.1%) and positive predictive value (83.5%). The area under the curve for TCFT was significantly higher than that for fTRST (0.788 vs. 0.748; p = 0.012). All tools predicted poor survival, with TCFT exhibiting a more consistent prognostic performance across thresholds than fTRST.ConclusionFrailty is prevalent and prognostically significant in non-older patients with cancer. TCFT demonstrated superior diagnostic and prognostic utility compared with fTRST, supporting its integration into routine frailty screening for this population.