The performance of three oncogeriatric screening tools - G8, optimised G8 and CARG - in predicting chemotherapy-related toxicity in older patients with cancer. A prospective clinical study (original) (raw)
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The Oncologist, 2016
Background. A multidimensional geriatric assessment (GA) is recommended in older cancer patients to inventory health problems and tailor treatment decisions accordingly but requires considerable time and human resources. The G8 is among the most sensitive screening tools for selecting patients warranting a full GA but has limited specificity. We sought to develop and validate an optimized version of the G8. Patients and Methods. We used a prospective cohort of cancer patients aged ≥70 years referred to geriatricians for GA (2007–2012: n = 729 [training set]; 2012–2014: n = 414 [validation set]). Abnormal GA was defined as at least one impaired domain across seven validated tests. Multiple correspondence analysis, multivariate logistic regression, and bootstrapped internal validation were performed sequentially. Results. The final model included six independent predictors for abnormal GA: weight loss, cognition/mood, performance status, self-rated health status, polypharmacy (≥6 medi...
Cureus, 2022
Performance status (PS) scales such as the Eastern Cooperative Oncology Group (ECOG) PS and the Karnofsky Performance Index have limited utility in selecting therapies and predicting related adverse events in older patients with cancer. In July 2016, medical oncologists at our institution adopted the Cancer and Aging Research Group toxicity prediction score (CARG), a toxicity prediction tool, to identify patients who are "fit" for chemotherapy versus those who are "frail" and may experience severe complications. Methods Our retrospective review included referrals of beneficiaries 75 years of age and older who received standard systemic therapy and patients of the same age whose treatment was modified due to CARG. We compared the score's utilization six months before and after its incorporation and then assessed how its application impacted admissions, emergency department (ED) visits, and medical management. Results Thirty-eight patients with a mean age of 81 years met the inclusion criteria. Their diagnoses included gastrointestinal (37%), lung (21%), hematologic (18%), breast (10.5%), genitourinary (3%), and other (10.5%) malignancies. CARG was documented for 12.5% of systemic therapy recipients before its adoption and 41% of recipients after adoption. Its use was limited by the reliance on physicians to perform scoring during time-constrained patient encounters. Patients had fewer mean inpatient admissions (0.7 versus 2.3), admission days (4.3 versus 8), and ED visits (1.1 versus 2.5) when management was modified based on the score. Conclusion CARG assessment may facilitate a safer and more tailored approach to cancer care in older patients than conventional PS scales alone. Its integration into patient screening would increase its application and better define its potential predictive capacity to decrease risks for hospitalization.
BMJ Open, 2021
ImportanceThe Cancer Aging Research Group (CARG) toxicity score is used to assess toxicity risk in geriatric patients receiving chemotherapy.ObjectiveThe primary aim was to validate the CARG score in geriatric patients treated with curative intent chemotherapy in predicting grade 3–5 toxicities.DesignThis was a longitudinal prospective observational study.SettingTata Memorial Hospital, Mumbai, India, a tertiary cancer care referral centre.ParticipantsPatients, aged ≥65 years, with gastrointestinal, breast or gynaecological stage I–III cancers being planned for curative intent chemotherapy. A total of 270 patients were required for accrual in the study.Exposure(s)Total risk score ranged from 0 (lowest toxicity risk) to 19 (highest toxicity risk).Main outcome(s) and measure(s)The primary endpoint of the study was to evaluate whether the CARG risk score predicted for grade 3–5 toxicities.ResultsThe study cohort of 270 patients had a mean age of 69 (65–83) years, with the most common ca...
European Journal of Cancer, 2011
Background: Frailty is an important factor to be considered in the senior cancer patient (pt). The Comprehensive Geriatric Assessment (CGA) is considered to be the gold standard to evaluate frailty in this pt population but its routine use in clinical practice is difficult. Therefore, screening instruments are needed to identify cancer pts who can be treated according to standard guidelines or are in need for a full CGA with geriatric interventions. The G8 questionnaire is a short and simple screening tool and was compared with the CGA to distinguish fit from unfit pts. Materials and Methods: Eligible pts were evaluated by the G8 questionnaire [score range: 0 (poor score) to 17 (good score)] and a full CGA to discriminate fit from unfit pts. The CGA evaluated function, mobility, nutrition, co-morbidity, cognition, depression and social support. Pts were considered unfit (vulnerable or frail) if there was more than 1 deficit within the CGA. Cutoff point used for the G8 questionnaire was a G8 score 14 for unfit pts. ROC analysis was used to evaluate the overall performance of the G8 questionnaire compared to the CGA. Results: 135 cancer pts were recruited from two sites in Belgium. Median age was 77 years old (range 66−97 years). Most prevalent types of cancer were urological cancers (22%), head and neck cancers (21%), cancer of the digestive system (17%), breast cancer (16%) and lung cancer (13%). According to the CGA, 44% of patients were considered unfit. The G8 questionnaire screened 75% of the patients as unfit with a sensitivity of 92% (95% confidence interval [CI]: 82−97%), a specificity of 39% (95% CI: 28−51%), a positive predictive value of 55% (95% CI: 44−64%) and a negative predictive value of 85% (95% CI: 68−95%). 62% of the pts were correctly classified. The Area Under the ROC Curve (AUC) was 0.85 (Standard error 0.03; 95% CI: 0.78-0.90). Conclusions: Overall the G8 questionnaire had a good ability (AUC=0.85) to discriminate fit from unfit patients in our sample compared to the CGA. For a cutoff point G8 score 14 the sensitivity was very high, but unfortunately the specificity or the probability to correctly identify fit patients was poor.
Oncologie, 2023
Objectives: This study aimed to evaluate the predictive value of the Cancer Aging Research Group (CARG) in Iranian patients as a representative of the Middle East North Africa (MENA) region population. Methods: This prospective longitudinal study involved patients 65 years and older starting a new cytotoxic chemotherapy regimen. We did general (including Karnofsky performance status, KPS) and CARG-based assessments before chemotherapy. Chemotherapy toxicities were recorded during chemotherapy courses. The predictive values of CARG and KPS were evaluated using the area under the receiver-operating characteristic curve (AUC-ROC). Chemotherapy toxicities were sub-analyzed per hematologic and nonhematologic types. Results: Chemotherapy-related toxicity was reported in 23.6 % of patients. The corresponding area under the receiver-operating characteristic curve (AUC-ROC) was 0.56 (95 %CI, 0.40-0.69) for total toxicity, 0.67 (95 % CI, 0.48-0.78) for hematologic toxicity, and 0.39 (95 %CI, 0.21-0.66) for nonhematologic toxicity. Conclusions: CARG model had an acceptable ability to predict hematologic toxicities; however, its efficacy for total and nonhematologic toxicities was limited.
BMC Geriatrics
Background Pre-treatment evaluation for sarcopenia is recommended in cancer patients. New screening tests that are less time-consuming and can identify patients who will potentially benefit from geriatric assessment are being developed; the G8 geriatric screening test is one such example. We aimed to investigate whether the G8 screening test can detect probable sarcopenia and is valid and reliable compared to a comprehensive geriatric assessment (CGA) in Turkish older adults with solid cancers. Methods We included solid cancer patients referred to a single center. Probable sarcopenia and abnormal CGA were defined as low handgrip strength. Cut-offs for handgrip strength in the Turkish population have been previously determined to be 32 kg for males and 22 kg for females and impairment in at least one of the CGA tests, respectively. The CGA tests comprised KATZ Basic Activities of Daily Living Scale Lawton–Brody Instrumental Activities of Daily Living Scale, Mini-Mental-State Examinat...
Annals of oncology : official journal of the European Society for Medical Oncology / ESMO, 2015
Screening tools are proposed to identify those older cancer patients in need of geriatric assessment (GA) and multidisciplinary approach. We aimed to update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on the use of screening tools. SIOG composed a task group to review, interpret and discuss evidence on the use of screening tools in older cancer patients. A systematic review was carried out and discussed by an expert panel, leading to a consensus statement on their use. Forty-four studies reporting on the use of 17 different screening tools in older cancer patients were identified. The tools most studied in older cancer patients are G8, Flemish version of the Triage Risk Screening Tool (fTRST) and Vulnerable Elders Survey-13 (VES-13). Across all studies, the highest sensitivity was observed for: G8, fTRST, Oncogeriatric screen, Study of Osteoporotic Fractures, Eastern Cooperative Oncology Group-Performance Status, Senior Adult Oncology Program (SAOP) 2...
Use of comprehensive geriatric assessment in older cancer patients
Critical Reviews in Oncology/Hematology, 2005
Background: As more and more cancers occur in elderly people, oncologists are increasingly confronted with the necessity of integrating geriatric parameters in the treatment of their patients. Methods: The International Society of Geriatric Oncology (SIOG) created a task force to review the evidence on the use of a comprehensive geriatric assessment (CGA) in cancer patients. A systematic review of the evidence was conducted. Results: Several biological and clinical correlates of aging have been identified. Their relative weight and clinical usefulness is still poorly defined. There is strong evidence that a CGA detects many problems missed by a regular assessment in general geriatric and in cancer patients. There is also strong evidence that a CGA improves function and reduces hospitalization in the elderly. There is heterogeneous evidence that it improves survival and that it is cost-effective. There is corroborative evidence from a few studies conducted in cancer patients. Screening tools exist and were successfully used in settings such as the emergency room, but globally were poorly tested. The article contains recommendations for the use of CGA in research and clinical care for older cancer patients. Conclusions: A CGA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival. The task force cannot recommend any specific tool or approach above others at this point and general geriatric experience should be used.