Resilience Enhancement Using Electronic Frailty Index-Directed Care Pathway

This is a prospective single-arm intervention trial of patients aged 65 or older with an active cancer diagnosis who are planned to receive chemotherapy and are eFI (Electronic Health Record (EHR)-based frailty index) pre-frail or frail.

Patients will be enrolled before initiation of chemotherapy. Following a baseline assessment, subjects will be provided with results regarding their frailty, will be offered referrals for supportive care interventions and will participate in weekly symptom reporting (electronic survey + phone call from research nurse) for 12 weeks. Follow-up assessments will be completed at 12 weeks and a subset of participants and providers in participating clinics will be contacted to consent and participate in an interview to provide feedback on the intervention including barriers/facilitators.

Inclusion criteria

Patients with cancer:

• Ability to understand and willingness to sign an IRB-approved informed consent
• Age ≥ 65 years at the time of enrollment.
• Planned to initiate an outpatient chemotherapy regimen (including myelosuppressive biologic/immune therapies) for cancer treatment (any type or stage), either as an initial therapy or as a new line of therapy, with curative or palliative intent.
• eFI pre-frail or frail status (available in EHR; defined as eFI > 0.10) within 30 days before enrollment.
• Ability to read and understand the English language

Providers:

• Treating medical oncologist of at least one patient participant who enrolled on to the study and completed baseline assessment.

Exclusion criteria

Patients:

• Documented physical or psychological comorbidity that would limit participant's ability to understand or comply with study procedures for the entire length of the study per the enrolling investigator.
• Chemotherapy planned at a facility outside the Atrium Health system.
• Currently receiving chemotherapy (defined as planned to continue an on-going treatment rather than starting a new regimen).