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FARGO-360: a multi-disciplinary survey of practice and perspectives on provision of care for patients with frailty presenting with gynecological cancers in the UK and Ireland
  1. Yee-Loi Louise Wan1,
  2. Gemma Cass2,
  3. Anna Collins3,
  4. Meera Adishesh4,
  5. Susan Addley5,
  6. Holly Baker-Rand6,
  7. Rasiah Bharathan7,
  8. Dominic Blake8,
  9. James Beirne9,
  10. Lisa Canavan10,
  11. James Dilley11,
  12. Gary Fitzgibbon12,
  13. Kate Glennon13,
  14. Narthana Ilenkovan14,
  15. Eleanor Jones1,
  16. Tabassum Khan15,
  17. Thumuluru Kavitha Madhuri16,17,
  18. Victoria McQueen18,
  19. Alison Montgomery19,
  20. Rachel Louise O'Donnell20,
  21. Sven Watmore21,
  22. Philip White22 and
  23. Gemma Louise Owens1
  24. The Audit and Research in Gynaecological Oncology (ARGO) Collaborative
  1. 1Gynaecological Oncology, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
  2. 2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3Leicester Cancer Research Centre, Leicester, UK
  4. 4Gynaecological Oncology, Royal Preston Hospital, Preston, UK
  5. 5Gynaecological Oncology, Royal Derby Hospital, Derby, UK
  6. 6Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  7. 7University Hospitals of Leicester NHS Trust, Leicester, UK
  8. 8Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead, UK
  9. 9Trinity Saint James Cancer Institute, Dublin, Ireland
  10. 10Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
  11. 11Gynaecological Oncology, Barts Health NHS Trust, London, UK
  12. 12Southampton University Hospitals NHS Trust, Southampton, UK
  13. 13Mater Misericordiae University Hospital, Dublin, Ireland
  14. 14Royal Hallamshire Hospital, Sheffield, UK
  15. 15Gynaecological Oncology, University of Birmingham, Birmingham, UK
  16. 16Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, UK
  17. 17School of Pharmacy, University of Brighton Faculty of Health and Social Sciences, Brighton, UK
  18. 18Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
  19. 19Gynaecology, East Surrey Hospital, Redhill, UK
  20. 20Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  21. 21Nottingham University Hospitals NHS Trust, Nottingham, UK
  22. 22University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
  1. Correspondence to Dr Yee-Loi Louise Wan, Gynaecological Oncology, The University of Manchester Faculty of Biology Medicine and Health, Manchester M13 9PL, UK; louise.wan{at}


Objectives Frailty has been associated with worse cancer-related outcomes for people with gynecological cancers. However, the lack of clear guidance on how to assess and modify frailty prior to instigating active treatments has the potential to lead to large variations in practice and outcomes. This study aimed to evaluate current practice and perspectives of healthcare practitioners on the provision of care for patients with frailty and a gynecological cancer.

Methods Data were collected via a questionnaire-based survey distributed by the Audit and Research in Gynecological Oncology (ARGO) collaborative to healthcare professionals who identified as working with patients with gynecological malignancies in the United Kingdom (UK) or Ireland. Study data were collected using REDCap software hosted at the University of Manchester. Responses were collected over a 16 week period between January and April 2021.

Results A total of 206 healthcare professionals (30 anesthetists (14.6%), 30 pre-operative nurses (14.6%), 51 surgeons (24.8%), 34 cancer specialist nurses (16.5%), 21 medical/clinical oncologists (10.2%), 25 physiotherapists/occupational therapists (12.1%) and 15 dieticians (7.3%)) completed the survey. The respondents worked at 19 hospital trusts across the UK and Ireland. Frailty scoring was not routinely performed in 63% of care settings, yet the majority of practitioners reported modifying their practice when providing and deciding on care for patients with frailty. Only 16% of organizations surveyed had a dedicated pathway for assessment and management of patients with frailty. A total of 37% of respondents reported access to prehabilitation services, 79% to enhanced recovery, and 27% to community rehabilitation teams.

Conclusion Practitioners from all groups surveyed considered that appropriate training, dedicated pathways for optimization, frailty specific performance indicators and evidence that frailty scoring had an impact on clinical outcomes and patient experience could all help to improve care for frail patients.

  • Preoperative Care
  • Quality of Life (PRO)/Palliative Care
  • Genital Neoplasms, Female
  • Surgical Procedures, Operative
  • Anesthesia, General

Data availability statement

Data are available upon reasonable request.

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  • Contributors Y-LLW, RB, DB, GC, EJ, TK, GLO designed and implemented the study. Y-LLW, GC, AC, GLO interpreted the data, drafted and revised the final manuscript. GC, AC, MA, SA, HBR, RB, DB, JB, LC, JD, GF, KG, NI, TK, TKM, VM, AM, RLO, SW, PW GLO acquired data via participant recruitment, revised and approved the final manuscript. Y-LLW acts as guarantor for the article and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.