Summary
Background: The aim of this study was to identify an appropriate screening instrument for the identification of frail elderly patients in a tertiary cancer center. In order to improve cancer care for older patients, the use of a geriatric assessment (GA) has been proposed to identify frail patients or those who are at a higher risk for chemotherapy-related toxicities. In busy clinical routine, an appropriate screening instrument could be used to spare time- and resource-consuming application of GA. Patients and Methods: We administered the Vulnerable Elders Survey (VES-13), G8 questionnaire, and Predictors of Toxicity (POT) as well as a GA at the first visit of 84 consecutive patients at a single Comprehensive Cancer Center. Analysis for patients' characteristics as well as sensitivity, specificity, and positive and negative predictive value (npv) was conducted. Results: The median age of the patients was 73 years (range 63-93 years), 61.9% were male, most (63%) suffered from gastrointestinal tumors, 39.3% had a multiple cancer diagnosis, and 53.6% had metastasis. 30 (35.7%) individuals were classified as ‘frail' by the GA. Sensitivity of G8 was 38.3%, and the npv was 63.8%. Sensitivity for VES-13 was 57.1%, and npv was 76.3%. Sensitivity of POT was 72.7%, and the npv was 80.6%. Conclusion: For the first time, the VES-13, G8, and POT are compared in a sample of older German patients. The POT seems to be a sufficient screening tool to identify frail patients in a tertiary referral cancer center and helps to save time and resources compared with a complete GA.
Journal Section:
Original Article
References
1.
Yancik R: Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 1997;80:1273-1283.
[PubMed]
2.
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA: Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 2009;27:2758-2765.
[PubMed]
3.
Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, et al.: Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol 2015;26:288-300.
[PubMed]
4.
Pallis AG, Fortpied C, Wedding U, Van Nes MC, Penninckx B, Ring A, et al.: EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer 2010;46:1502-1513.
[PubMed]
5.
Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen MLG, Extermann M, et al.: International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014;32:2595-2603.
[PubMed]
6.
Van Bekkum ML, van Munster BC, Thunnissen PLM, Smorenburg CH, Hamaker ME: Current palliative chemotherapy trials in the elderly neglect patient-centred outcome measures. J Geriatr Oncol 2015;6:15-22.
[PubMed]
7.
Lamont EB, Schilsky RL, He Y, Muss H, Cohen HJ, Hurria A, et al.: Generalizability of trial results to elderly medicare patients with advanced solid tumors (alliance 70802). J Natl Cancer Inst 2015;107:336.
[PubMed]
8.
Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD, et al.: Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 2004;52:625-634.
[PubMed]
9.
Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC: Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol 2012;13:e437-e444.
[PubMed]
10.
Rockwood K, Mitnitski A: Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med 2011;27:17-26.
[PubMed]
11.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al.: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-M157.
[PubMed]
12.
Aparicio T, Jouve J-L, Teillet L, Gargot D, Subtil F, Le Brun-Ly V, et al.: Geriatric factors predict chemotherapy feasibility: ancillary results of FFCD 2001-02 phase III study in first-line chemotherapy for metastatic colorectal cancer in elderly patients. J Clin Oncol 2013;31:1464-1470.
[PubMed]
13.
Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz J-P, Lichtman S, et al.: Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 2005;55:241-252.
[PubMed]
14.
Tucci A, Ferrari S, Bottelli C, Borlenghi E, Drera M, Rossi G: A comprehensive geriatric assessment is more effective than clinical judgment to identify elderly diffuse large cell lymphoma patients who benefit from aggressive therapy. Cancer 2009;115:4547-4553.
[PubMed]
15.
Luciani A, Ascione G, Bertuzzi C, Marussi D, Codecà C, Maria GD, et al.: Detecting disabilities in older patients with cancer: comparison between comprehensive geriatric assessment and Vulnerable Elders Survey-13. J Clin Oncol 2010;28:2046-2050.
[PubMed]
16.
Bellera CA, Rainfray M, Mathoulin-Pélissier S, Mertens C, Delva F, Fonck M, et al.: Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 2012;23:2166-2172.
[PubMed]
17.
Monfardini S, Basso U, Fiduccia P, Brunello A, Baretta Z, Soldà C, et al.: Can the short screening test Vulnerable Elders Survey 13 (VES-13) substitute for the time-consuming comprehensive geriatric assessment (CGA) to identify vulnerable/frail elderly breast cancer patients. ASCO Annual Meeting 2010. J Clin Oncol 2010;28(15s suppl):abstr 9114.
18.
Soubeyran P, Bellera C, Goyard J, Heitz D, Curé H, Rousselot H, et al.: Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS ONE 2014;9:e115060.
[PubMed]
19.
Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H, et al.: Developing a cancer-specific geriatric assessment. Cancer 2005;104:1998-2005.
[PubMed]
20.
Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al.: Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011;29:3457-3465.
[PubMed]
21.
Stokoe JM, Pearce J, Sinha R, Ring A: G8 and VES-13 scores predict chemotherapy toxicity in older patients with cancer. J Geriatr Oncol 2012;3:S81.
22.
Falandry C, Brain E, Bonnefoy M, Mefti F, Jovenin N, Rigal O, et al.: Impact of geriatric risk factors on pegylated liposomal doxorubicin tolerance and efficacy in elderly metastatic breast cancer patients: final results of the DOGMES multicentre GINECO trial. Eur J Cancer 2013;49:2806-2814.
[PubMed]
23.
Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, et al.: Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 2012;118:3377-3386.
[PubMed]
24.
Trautmann F, Hentschel L, Hornemann B, Rentsch A, Baumann M, Ehninger G, et al.: Electronic real-time assessment of patient-reported outcomes in routine care-first findings and experiences from the implementation in a comprehensive cancer center. Support Care Cancer 2016;Epub ahead of print.
[PubMed]
25.
Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, et al.: Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 2012;62:220-241.
[PubMed]
26.
Hoppe S, Rainfray M, Fonck M, Hoppenreys L, Blanc J-F, Ceccaldi J, et al.: Functional decline in older patients with cancer receiving first-line chemotherapy. J Clin Oncol 2013;31:3877-3882.
[PubMed]
27.
Kenis C, Decoster L, Van Puyvelde K, De Grève J, Conings G, Milisen K, et al.: Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 2014;32:19-26.
[PubMed]
28.
Pottel L, Lycke M, Boterberg T, Pottel H, Goethals L, Duprez F, et al.: G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy. BMC Cancer 2015;15:875.
[PubMed]
29.
Kellen E, Bulens P, Deckx L, Schouten H, Van Dijk M, Verdonck I, et al.: Identifying an accurate pre-screening tool in geriatric oncology. Crit Rev Oncol Hematol 2010;75:243-248.
[PubMed]
30.
Molina-Garrido MJ, Guillen-Ponce C: Comparison of two frailty screening tools in older women with early breast cancer. Crit Rev Oncol Hematol 2011;79:51-64.
[PubMed]
31.
Baitar A, Van Fraeyenhove F, Vandebroek A,De Droogh E, Galdermans D, Mebis J, et al.: Evaluation of the Groningen Frailty Indicator and the G8 questionnaire as screening tools for frailty in older patients with cancer. J Geriatr Oncol 2012;4:32-38.
[PubMed]
32.
Mehnert A, Müller D, Lehmann C, Koch U: Die deutsche Version des NCCN Distress-Thermometers: Empirische Prüfung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 2006;54:213-223.
33.
Rubenstein LZ, Harker JO, Salvà A, et al.: Screening for undernutrition in geriatric practice: developing the Short-Form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001;56:M366-M372.
[PubMed]
34.
Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.
[PubMed]
35.
Min LC, Elliott MN, Wenger NS, Saliba D: Higher Vulnerable Elders Survey Scores Predict Death and Functional Decline in Vulnerable Older People. J Am Geriatr Soc 2006;54:507-511.
[PubMed]
36.
Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, et al.: The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc 2001;49:1691-1699.
[PubMed]
37.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al.: Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-655.
[PubMed]
38.
IBM SPSS Statistics for Windows, version 22.0. New York, NY, IBM Corporation, 2013.
39.
Dubruille S, Bron D, Roos M, Vandenbossche S, Meuleman N, Maerevoet M, et al.: The respective usefulness of the G8 and a comprehensive geriatric assessment (CGA) to predict intolerance to chemotherapy and survival of fit and vulnerable older patients with hematological malignancies. J Geriatr Oncol 2013;4:S56.
40.
Soubeyran P, Bellera C, Goyard J: Validation of the G8 screening tool in geriatric oncology: the ONCODAGE project. J Clin Oncol 2011;29(suppl):abstr 9001.
41.
Mohile SG, Bylow K, Dale W, Dignam J, Martin K, Petrylak DP, et al.: A pilot study of the vulnerable elders survey-13 compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation. Cancer 2007;109:802-810.
[PubMed]
42.
Smets IHGJ, Kempen GIJM, Janssen-Heijnen MLG, Deckx L, Buntinx FJVM, van den Akker M: Four screening instruments for frailty in older patients with and without cancer: a diagnostic study. BMC Geriatr 2014;14:26.
[PubMed]
43.
Pottel L, Boterberg T, Pottel H, Goethals L, Van Den Noortgate N, Duprez F, et al.: Determination of an adequate screening tool for identification of vulnerable elderly head and neck cancer patients treated with radio(chemo)therapy. J Geriatr Oncol 2012;3:24-32.
44.
Owusu C, Koroukian SM, Schluchter M, Bakaki P, Berger NA: Screening older cancer patients for a Comprehensive Geriatric Assessment: a comparison of three instruments. J Geriatr Oncol 2011;2:121-129.
[PubMed]
45.
Wildes TM, Ruwe AP, Fournier C, Gao F, Carson KR, Piccirillo JF, et al.: Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancer. J Geriatr Oncol 2013;4:227-234.
[PubMed]
46.
Podsiadlo D, Richardson S: The timed ‘Up & Go': a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142-148.
[PubMed]
47.
Dean CM, Richards CL, Malouin F: Walking speed over 10 metres overestimates locomotor capacity after stroke. Clin Rehabil 2001;15:415-421.
[PubMed]
48.
Lange M, Rigal O, Clarisse B, Giffard B, Sevin E, Barillet M, et al.: Cognitive dysfunctions in elderly cancer patients: a new challenge for oncologists. Cancer Treat Rev 2014;40:810-817.
[PubMed]
49.
Atreja A, Rizk M: Capturing patient reported outcomes and quality of life in routine clinical practice: ready for prime time? Minerva Gastroenterol Dietol 2012;58:19-24.
[PubMed]
50.
Kallen MA, Yang D, Haas N: A technical solution to improving palliative and hospice care. Support Care Cancer 2011;20:167-174.
[PubMed]
51.
Hilarius DL, Kloeg PH, Gundy CM, Aaronson NK: Use of health-related quality-of-life assessments in daily clinical oncology nursing practice. Cancer 2008;113:628-637.
[PubMed]
52.
Pergolotti M, Deal AM, Williams GR, et al.: Health related quality of life (HRQOL) in older adults with cancer: the potential of a single-item screen. ASCO Annual Meeting 2015. J Clin Oncol 2015;33(suppl): abstr 9533.
© 2016 S. Karger GmbH, Freiburg
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2016
You do not currently have access to this content.
