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Electronic Rapid Fitness Assessment (eRFA)

The electronic Rapid Fitness Assessment (eRFA) is a questionnaire developed at Memorial Sloan Kettering and used by all the doctors on the Geriatrics Service to gauge and understand an older patient’s level of fitness.

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Why it is important to use the eRFA?

Studies have shown that fitness of cancer patients can predict their outcomes. Those who are frail need more supportive care during the course of cancer treatment than those who are fit. Not recognizing the fitness status of cancer patients may expose them to unnecessary risks, side effects, and complications. Multiple organizations such as the American Geriatrics Society, American College of Surgeons, National Comprehensive Cancer Network, and International Society of Geriatric Oncology have called for the incorporation of more comprehensive fitness assessment into the care of older adults with cancer.

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What does eRFA assess?

The assessment includes questions related to a patient’s functional status (Karnofsky Performance Status, Basic and Instrumental Activities of Daily Living, use of assistive device, history and number of falls in the past year, and Timed Up and Go test, quality of vision and hearing); level of social support (Medical Outcome Study — four-item) and social activity (Medical Outcome Study-Social Activity questionnaire); emotional well-being (Distress Thermometer and Geriatric Depression Scale — four item); nutritional status; polypharmacy; and cognitive assessment (Mini-Cog).

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How was the eRFA developed?

The eRFA was developed through collaboration between MSK’s Geriatrics Service and the Webcore Service. The Geriatrics Service is part of the Division of Survivorship and Supportive Care in the Department of Medicine. The Webcore Service is a National Cancer Institute–funded service to develop secured web-based questionnaires. Armin Shahrokni leads the clinical effort, and Andrew Vickers leads the technical and biostatistical efforts related to the eRFA.

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Who funded the development of the eRFA?

The development of the eRFA became possible in part through generous funding by the Samuel and Beatrice Seaver Cancer and Aging Fund.

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When was the eRFA is developed and implemented?

The eRFA was developed during 2014. In 2015, Dr. Shahrokni conducted a successful pilot study in his geriatrics clinic. Subsequently, the eRFA was expanded to all other geriatrics clinics. In 2016, the Thoracic Surgery and Bone Marrow Transplant Services implemented the eRFA in their clinics. Currently, the eRFA is utilized as standard of care in all geriatrics clinics as well as by the Thoracic Surgery and Bone Marrow Transplant services.

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What do the clinicians do with the information obtained through the eRFA?

Results of the eRFA are available for the clinician to review at the time of the encounter before assessing the patient. This ensures a comprehensive assessment of older adults with cancer and the identification of syndromes that may need intervention before, during, or after treatment. In addition, the data is captured in a secured Webcore data warehouse for future analysis.

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How many patients have completed the eRFA?

As of July 2017, approximately 2,700 patients completed the eRFA.

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How do patients complete the eRFA?

Patients may complete the assessment at home if they have access to email and the internet. If they don’t have access to email or to the internet, they can complete the eRFA at the visit with the clinician while waiting in the waiting area using tablets.

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How long does it take to complete the eRFA?

The median time to complete the eRFA is 11 minutes. Patients who are frail may need more time to complete the eRFA.

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Who has completed the eRFA?

In our dataset, about 50 percent completed the eRFA on their own, while 35 percent completed the eRFA with some assistance from their family members. Only 15 percent asked their family members or other caregivers to complete the eRFA for them.

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Are patients satisfied with completing the eRFA?

Yes. Our pilot study in 2015 showed that the overwhelming majority of patients were satisfied with completing the eRFA.

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If my service is interested in knowing more about the eRFA, what should we do?

You can reach out to Dr. Shahrokni at shahroka@mskcc.org or 646-888-3651.

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Are there any publications or presentation on the eRFA?

  • Shahrokni, A., Vickers, A. J., Mahmoudzadeh, S., & Korc-Grodzicki, B. (2016). Assessing the clinical feasibility of electronic Rapid Fitness Assessment (eRFA): A novel geriatric assessment tool for the oncology setting.
  • Shahrokni, A., Tin, A., Downey, R. J., Strong, V., Mahmoudzadeh, S., Boparai, M. K., … & Korc-Grodzicki, B. (2017). Electronic rapid fitness assessment: A novel tool for preoperative evaluation of the geriatric oncology patient. Journal of the National Comprehensive Cancer Network, 15(2), 172-179.
  • Downey, R. J., Korc-Grodzicki, B., Weber, R., Vickers, A. J., Jones, D. R., Bains, M. S., & Shahrokni, A. (2017). Assessing the clinical feasibility of implementing a novel assessment of frailty: The electronic Rapid Fitness Assessment in diverse thoracic surgery clinics.
  • Shahrokni, A., Tin, A., Aiken, W. N., Vickers, A. J., & Korc-Grodzicki, B. (2017). Development of 3-item questionnaire for preoperative evaluation of older cancer patients.
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I work outside of Memorial Sloan Kettering Cancer Center, but I am interested in knowing more about the eRFA.

Please reach out to Dr. Shahrokni at shahroka@mskcc.org or call 646-888-3651.

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Are there opportunities for medical students, residents, or fellows to do projects using the eRFA data?

Yes, you can reach out to Dr. Shahrokni at shahroka@mskcc.org or call 646-888-3651. 

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What additional data in the dataset is available to the researcher?

For the surgical patients, in addition to the eRFA data, we currently have data on the type of surgical procedures, the duration of surgery, the amount of blood loss during surgery, hospital length of stay, ICU admission after surgery, surgical complications, hospital disposition, 30-, 90-, 180-, and 365-day mortality as well as overall mortality. More data will be added in the future.

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How much does it cost to implement the eRFA?

Please reach out to Dr. Shahrokni at shahroka@mskcc.org or call 646-888-3651.

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What supports are available to implement the eRFA?

The available support includes training of the administrative staff, nursing, and clinic staff. Technical support can be provided by Webcore.

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