Background: Frailty affects up to 50% of older adults with cancer and is associated with increased chemotherapy toxicity, unplanned hospitalisations, and poorer treatment outcomes. Early identification through nurse-led frailty screening may support personalised treatment planning and improve patient outcomes.
Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies published between 2017 and 2021 evaluating nurse-led frailty screening, comprehensive geriatric assessment (CGA), or multidisciplinary frailty interventions in oncology were included. Eligible study designs comprised randomised controlled trials, prospective cohort studies, pilot implementation studies, and service evaluations. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools.
Results: Eight studies met the inclusion criteria. Nurse-led frailty screening consistently improved identification of geriatric impairments and informed treatment decisions, including chemotherapy modification, supportive care referrals, and multidisciplinary interventions. Studies reported improved treatment tolerance, reduced treatment-related toxicity, fewer hospital presentations, and maintained or improved quality of life. Nurse-led models were feasible to implement in routine oncology practice and strengthened multidisciplinary care, although evidence for survival benefit remains limited.
Conclusion: Current evidence supports integrating nurse-led frailty screening into routine oncology care to improve frailty identification and guide individualised treatment decisions.
Next Steps: Findings from this review are informing the implementation of an evidence-based nurse-led geriatric frailty screening program for older adults with cancer in Gippsland. The program aims to improve early frailty identification, optimise treatment planning, and strengthen multidisciplinary care across regional oncology services.