The Prognostic Value of the Clinical Frailty Scale Without Category 9 in Older Adults with Advanced Cancer.

BACKGROUND: The Clinical Frailty Scale (CFS) is widely used, but the "terminally ill" category 9-defined by a <6-month prognosis-may limit nuanced survival estimation in geriatric oncology. OBJECTIVE: To evaluate the prognostic utility of the CFS when category 9 is omitted. METHODS: This retrospective study analyzed 901 older adults (≥65 years) with incurable cancer at a palliative clinic. Patients were stratified into CFS 2-5 (n = 618) and CFS 6-8 (n = 283). Survival was assessed using multivariate Cox regression. RESULTS: Median survival was significantly shorter for CFS 6-8 compared to CFS 2-5 (90 vs. 158 days; p < 0.001). For 3-month mortality, CFS 6-8 demonstrated a hazard ratio (HR) of 2.25 compared to CFS 2-5. After adjusting for age, symptoms, albumin, and comorbidities, the CFS remained an independent predictor of 3-month (HR 2.07) and 6-month mortality (HR 1.57). CONCLUSION: Omitting category 9 allows the CFS to provide meaningful prognostic data, facilitating better end-of-life planning in geriatric oncology.