Using The Rockwood Clinical Frailty Scale on Cancer Referrals

We are replacing the performance status with the Rockwood Clinical Frailty Scale (CFS) on all urgent suspected cancer referral forms from June 2025.

The initiative aims to enhance patient outcomes by integrating frailty assessments into oncology pathways.

If you would like to discuss these changes, please contact Mary Edwards, Frailty and Oncology Project Manager, at mary.edwards@wca.uhs.nhs.uk

Considering Frailty with Cancer Referrals in Primary Care

Click to download the presentation slides

What is the Clinical Frailty Scale (CFS)?

Click image to enlarge.

Why the CFS?

The CFS is more sensitive in highlighting physical and cognitive changes that may affect overall outcomes in people especially over the age of 65. This is proven in cancer research which has shown that a higher CFS is associated with:

poorer survival
post operative complications
toxicity
hospital admission and mortality
treatment discontinuation
faster progression of cancer

Identifying frailty status can trigger discussion at the point of referral about ability to cope with investigations and treatments. Once reaching oncology services the CFS score will enable oncology services to improve triage, initiate further assessments, and plan tailored management for frail patients in line with the Joint Collegiate Council for Oncology (JCCO) Guidance (2024): Implementing Frailty Assessment and Management in Oncology Services. Please see figure 1, below:

How will it work?

Quick and Simple: Completing the CFS takes less than a minute.
Support Available: A Quick Reference Guide, an app version, and other educational resources are provided to help clinicians assess frailty effectively (see below).