Burden and impact of frailty and comorbidity in individuals screened for lung cancer

Abstract

Background: Individuals undergoing lung cancer screening (LCS) have high comorbidity burden, yet the extent and impact of frailty are unknown. We sought to characterize the predicted probability of frailty and comorbidity burden among individuals undergoing LCS and compare screening results and downstream healthcare utilization in those with less versus more frailty and comorbidity.

Methods: This cohort study linked North Carolina Lung Screening Registry data with Medicare, Medicaid, and private payor insurance claims from individuals undergoing baseline LCS between 2013-2020. We evaluated the predicted probability of frailty using the Faurot Frailty Index (FFI) and comorbidity using Charlson Comorbidity Score (CCS). We compared LCS imaging results by FFI and CCS, and rates of downstream imaging and invasive procedures by FFI and CCS using chi-square tests.

Results: Among 3,923 individuals screened, 82.1% had low FFI and 55% had CCS<2. CCS was higher among those with higher FFI (p<0.0001). LCS results did not differ based on FFI or CCS. In individuals with a negative LCS result, downstream imaging rates/100 persons were higher among persons with > low versus low FFI [22.3%(95%CI:18.8-25.8) versus 16.1%(95%CI:14.7-17.6), respectively] and among those with CCS≥2 versus CCS<2 [20.2%(95%CI:18.2-22.3) versus 14.8%(95%CI:13.1-16.5), respectively].

Conclusion: Individuals undergoing LCS have similar frailty burden to the general older adult population. More versus less frail individuals had higher comorbidity burden.

Impact: Our novel finding that the majority of screened individuals had low predicted probability of frailty provides some reassurance that few individuals with screen-detected lung cancer may be unable to undergo treatment based on frailty criteria.