The implementation of frailty assessment in gynecologic oncology: an international multicenter JAGO-NOGGO survey

Abstract

Purpose

The global aging trend is expected to double the population aged 65 and older by 2050, posing new challenges for healthcare systems. Frailty is associated with poorer prognosis, increased postoperative complications, and reduced treatment tolerance. Accurate frailty assessment (FA) is therefore crucial for diagnosis, risk stratification, and individualized treatment planning. Despite its clinical relevance, clear evidence-based guidance for implementation in gynecologic oncology remains lacking.

Methods

An anonymous online survey with 51 multiple-choice and open-ended questions was conducted from May to August 2022. It targeted gynecologists and oncologists in Germany, Austria, and Switzerland, and was distributed to 633 healthcare institutions.

Results

A total of 112 responses were analyzed, revealing considerable variation in the application of frailty assessments. Only 11% reported routine use, while 36% applied FA selectively. Screening tools varied: 52% used institution-specific forms, while validated instruments such as G8 or VES-13 were rarely used. Timing was inconsistent: 49% performed FA preoperatively, 36% before chemotherapy, 31% at first presentation, and 30% without a fixed timepoint. Prehabilitation programs were largely absent; only 21% of institutions offered them. 77% of respondents indicated a need for further training.

Conclusion

There are substantial gaps in the use of frailty assessments in gynecologic oncology. Standardized procedures, prehabilitation programs, and targeted education are essential to improve care quality and treatment outcomes in the context of an aging patient population.