Improving Frailty Assessment in Older Adults with Bladder Cancer: A Quality Improvement Audit and Re-Audit at Oxford University Hospitals.
Abstract
Title:
Improving Frailty Assessment in Older Adults with Bladder Cancer: A Quality Improvement Audit and Re-Audit at Oxford University Hospitals.
Background:
Frailty assessment is a crucial element of personalised care in older cancer patients. In bladder cancer, treatment options, ranging from radical cystectomy to conservative or palliative management, must consider physiological resilience rather than chronological age. Despite national recommendations to record frailty assessments, local compliance remained inconsistent.
Aim:
To evaluate and improve compliance with frailty assessment documentation for bladder cancer patients aged over 70 years at Oxford University Hospitals (OUH).
Methodology:
A retrospective audit included patients aged >70 years diagnosed with bladder cancer between 26th March and 11th July 2025. Data were collected from the Electronic Patient Record (EPR) for frailty assessment (Clinical Frailty Scale [CFS]), treatment pathway, and MDT documentation. Interventions included:
- Embedding a CFS prompt within the EPR oncology proforma.
- Educational sessions for urology and oncology teams.
- Regular reminders during MDT meetings.
A re-audit was conducted three months post-intervention.
Results:
Initial audit (n=48) showed frailty documentation in 29% of cases. Following interventions, re-audit data (n=46) demonstrated an increase to 78% compliance. Among reassessed patients, 41% were mildly frail (CFS 4–5) and 37% were moderately to severely frail (CFS ≥6). Clinicians reported improved awareness and use of frailty scores to guide treatment decisions.
Conclusion:
Simple system prompts and staff education significantly improved frailty assessment compliance in older adults with bladder cancer. Sustained reinforcement and periodic re-audits are recommended to maintain progress.