Journal of the Formosan Medical Association · Nov 2026
Prospective external validation of the Taiwan Cancer Frailty Tool versus Geriatric 8 for frailty screening in older Taiwanese patients with cancer
By Lu CH, Yeh KY, Hung YS et al.
Background Frailty strongly affects treatment tolerance and outcomes in older adults with cancer; however, routine use of comprehensive geriatric assessment (CGA) is limited owing to its complexity. We externally validated the Taiwan Cancer Frailty Tool (TCFT) against Geriatric 8 (G8) using CGA as the reference standard in a multicenter Taiwanese cohort. Methods We prospectively enrolled patients aged ≥65 years with newly diagnosed cancer across multiple Taiwanese centers (January 2021–December 2024). Within seven days before therapy, patients underwent CGA, TCFT, and G8. Diagnostic performance for CGA-defined frailty (≥2 impaired domains) was evaluated using receiver operating characteristic analysis and operating characteristics at prespecified cutoffs (TCFT ≥1; G8 ≤13). Prognostic value for overall survival (OS) was assessed using Kaplan-Meier and Cox models. Results Among 1339 patients (median age 71.6 years, range 65‒99), the CGA-defined frailty prevalence was 55.3%. The TCFT demonstrated higher discrimination than G8 (area under the curve 0.805 [95% confidence interval (CI) 0.782–0.829] vs. 0.767 [0.741–0.792]; absolute difference 0.038 [95% CI 0.003–0.073]; p = 0.032). At TCFT ≥1 and G8 ≤13, sensitivities were 91.6% and 75.8%, specificities 50.8% and 64.8%, and accuracies 77.3% and 70.9%, respectively. Frailty, defined by CGA, TCFT, or G8, predicted inferior OS (log-rank p < 0.001). Conclusions In this prospective external validation study, the TCFT demonstrated good diagnostic performance for CGA-defined frailty and modestly higher overall discrimination than the G8. Frailty identified by both the TCFT and G8 was associated with shorter overall survival. These findings support the TCFT as a brief frailty screening tool for identifying older Taiwanese patients with cancer who may benefit from further geriatric assessment.