Predictive values of two frailty screening tools in older patients with solid cancer: a comparison of SAOP2 and G8 (original) (raw)
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The Lancet Oncology, 2012
Aim: To assess which frailty screening tools demonstrate the best sensitivity and specificity for predicting the presence of impairments on comprehensive geriatric assessment (CGA) in older cancer patients. Method: A systematic search in Medline and Embase and hand-search of conference abstracts, for studies on the association between frailty screening tools and CGA in older cancer patients. Results: Literature search identified 4440 reports, of which 22 publications from 14 studies, assessing seven different frailty screening tools, were included in the review. Median sensitivity and specificity of the screening tools for frailty on CGA were respectively: Vulnerable Elders Survey-13 (VES-13) 68%/78%, Geriatric 8 (G8) 87%/61%, Triage Risk Screening tool (TRST, cut-off 1+) 91%/±45%, Groningen Frailty Index (GFI) ±50% /±75%, Fried frailty criteria, ±30%/±90%, Barber 59%/79%, and abbreviated CGA (aCGA) 51%/97%. However, even in case of the highest sensitivity, the negative predictive value was only 60%.
Journal of Clinical Oncology
PURPOSE The intended clinical value of frailty screening is to identify unfit patients needing geriatric assessment (GA) and to prevent unnecessary GA in fit patients. These hypotheses rely on the sensitivity and specificity of screening tests, but they have not been verified. METHODS We performed a cross-sectional analysis of outpatients age ≥ 70 years with prostate, breast, colorectal, or lung cancer included in the ELCAPA cohort study (ClinicalTrials.gov identifier: NCT02884375 ) between February 2007 and December 2019. The diagnostic accuracy of the G8 Geriatric Screening Tool (G8) and modified G8 scores for identifying unfit patients was determined on the basis of GA results. We used decision curve analysis to calculate the benefit of frailty screening for detecting unfit patients and avoiding unnecessary GA in fit patients across different threshold probabilities. RESULTS We included 1,648 patients (median age, 81 years), and 1,428 (87%) were unfit. The sensitivity and specifi...
Journal of Geriatric Oncology, 2013
In this study, we evaluated the Groningen Frailty Indicator (GFI) and the G8 questionnaire as screening tools for a Comprehensive Geriatric Assessment (CGA) in older patients with cancer. Patients and Methods: Eligible patients with various types and stages of cancer were evaluated for frailty before treatment. Patients were categorized as patients with a normal CGA and abnormal CGA (≥2 impaired tests). The diagnostic performance of the screening tools was evaluated against the CGA with Receiver Operating Characteristic analysis. Results: In total, 170 patients (79 women) with median age 77 years old (range 66-97 years) were included. Sixty-four percent of patients had an abnormal CGA while according to the GFI (GFI ≥4) and G8 questionnaire (G8≤14) 47% and 76% of patients had an abnormal screening test, respectively. Overall, there was no significant difference (p=0.97) in diagnostic performance between the two screening tools. The Area Under the Curve was 0.87 for both tools. For the GFI and G8 questionnaire the sensitivity was respectively 66% (95% CI: 56-75%), 92% (95% CI: 85-96%); the negative predictive value (NPV): 59% (95 CI%: 49-69%), 78% (95% CI: 63-88%); and the specificity: 87% (95% CI: 76-94%), 52% (95% CI: 39-65%). Conclusion: In this study, we showed that overall both the GFI and the G8 questionnaire were able to separate older patients with cancer with a normal and abnormal CGA. For the G8 questionnaire, an adequate sensitivity and NPV were demonstrated, however at the expense of the specificity. For the GFI, we suggest to lower the threshold with one point to GFI ≥3 to screen patients for a CGA.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017
Purpose Frailty classifications of older patients with cancer have been developed to assist physicians in selecting cancer treatments and geriatric interventions. They have not been compared, and their performance in predicting outcomes has not been assessed. Our objectives were to assess agreement among four classifications and to compare their predictive performance in a large cohort of in- and outpatients with various cancers. Patients and Methods We prospectively included 1,021 patients age 70 years or older who had solid or hematologic malignancies and underwent a geriatric assessment in one of two French teaching hospitals between 2007 and 2012. Among them, 763 were assessed using four classifications: Balducci, International Society of Geriatric Oncology (SIOG) 1, SIOG2, and a latent class typology. Agreement was assessed using the κ statistic. Outcomes were 1-year mortality and 6-month unscheduled admissions. Results All four classifications had good discrimination for 1-yea...
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.
Validation of a frailty index in older cancer patients with solid tumours
BMC Cancer, 2018
Background: Frailty is an indicator of physiological reserve in older people. In non-cancer settings, frailty indices are reliable predictors of adverse health outcomes. The aims of this study were to 1) derive and validate a frailty index (FI) from comprehensive geriatric assessment (CGA) data obtained in the solid tumour chemotherapy setting, and 2) to explore whether the FI-CGA could predict chemotherapy decisions and survival in older cancer patients with solid tumours. Methods: Prospective cohort study of a consecutive series sample of 175 cancer patients aged 65 and older with solid tumours. A frailty index was calculated using an accumulated deficits model, coding items from the comprehensive geriatric assessment tool administered prior to chemotherapy decision-making. The domains of physical and cognitive functioning, nutrition, mood, basic and instrumental activities of daily living, and comorbidities were incorporated as deficits into the model. Results: The FI-CGA had a right-skewed distribution, with median (interquartile range) of 0.27 (0.21-0.39). The 99% limit to deficit accumulation was below the theoretical maximum of 1.0, at 0.75. The FI-CGA was significantly related (p < 0.001) to vulnerability as assessed by the Vulnerable Elders Survey-13 and to medical oncologists' assessments of fitness or vulnerability to treatment. Baseline frailty as determined by the FI-CGA was also associated with treatment decisions (Treatment Terminated, Treatment Completed, No Planned Treatment) (p < 0.001), with the No Planned Treatment group significantly frailer than the other two groups. Conclusion: The FI-CGA is a potentially useful adjunct to cancer clinical decision-making that could predict chemotherapy outcomes in older patients with solid tumours.
International Survey on Frailty Assessment in Patients with Cancer
The Oncologist
Background Frailty negatively affects the outcomes of patients with cancer, and its assessment might vary widely in the real world. The objective of this study was to explore awareness and use of frailty screening tools among the ONCOassist healthcare professionals (HCPs) users. Materials and Methods We sent 2 emails with a cross-sectional 15-item survey in a 3-week interval between April and May 2021. Differences in the awareness and use of tools according to respondents’ continents, country income, and job types were investigated. Results Seven hundred thirty-seven HCPs from 91 countries (81% physicians, 13% nurses, and 5% other HCPs) completed the survey. Three hundred and eighty-five (52%) reported assessing all or the majority of their patients; 518 (70%) at baseline and before starting a new treatment. Three hundred and four (43%) HCPs were aware of performance status (PS) scores only, 309 (42%) age/frailty/comorbidity (AFC) screening, and 102 (14%) chemotoxicity predictive to...
Frailty status but not age predicts complications in elderly cancer patients: a follow-up study
Acta Oncologica
Objectives: The purposes were to investigate the health status of elderly cancer patients by comprehensive geriatric assessment (CGA) and to compare the complications with respect to baseline CGA and to evaluate the need for geriatric interventions in an elderly cancer patients' population. Material: Patients aged !70 years with lung cancer (LC), cancer of the head and neck (HNC), colorectal cancer (CRC), or upper gastro-intestinal cancer (UGIC) are referred to the Department of Oncology for cancer treatment. Methods: CGA was performed prior to cancer treatment and addressed the following domains: Activities of daily living (ADL), instrumental ADL (IADL), comorbidity, polypharmacy, nutrition, cognition, and depression. Complications, defined as dose reduction and discontinuation of treatment due to grade 3-4 toxicity, hospital admission, shift to palliative treatment, or death within 90 days, were identified from the medical files. Patients were classified as fit, vulnerable, or frail by CGA. Principal results: Patients (N ¼ 217) with a median age of 75 years (range: 70-93 yeas) were included: 13% were fit, 35% vulnerable, and 52% frail. CGA significantly predicted admittance to hospital in frail and vulnerable patients compared to fit patients: risk ratio (RR) 2.12 (95% CI: 1.01; 4.46). Vulnerable and frail patients had higher absolute risk of death within 90 days compared to fit patients: 7% and 23% versus 0%. HR for death within 90 days in frail patients as compared to vulnerable patients was 3.50 (95% CI: 1.34; 9.15). More frail patients (88%) needed geriatric interventions than the vulnerable (46%) and fit patients (32%). Major conclusion: Few elderly cancer patients seem to be fit. CGA predicts admittance to hospital in a population of elderly patients with mixed cancer diseases. Frail and vulnerable patients have higher risk of death within 90 days as compared to fit patients.
Journal of Geriatric Oncology, 2020
Objectives: A growing number of older patients with cancer require well-founded clinical decision-making. Frailty screening is suggested as a service to improve outcomes in vulnerable older patients with cancer. This prospective study examined the value of frailty screening to predict rapid functional decline, rapid progressive disease (PD) and shorter overall survival (OS) in older patients with gastrointestinal cancer receiving palliative chemotherapy. Materials and Methods: Patients aged ≥70 years were screened for frailty in an oncologic department after clinical decision but before starting palliative chemotherapy. Screening was repeated at first response evaluation after approximately two months of chemotherapy. Frailty screening tools included performance status (PS), Charlson Comorbidity Index, G-8 using two different cutoffs (G814,G811), VES-13, Timed-Up-and-Go, Handgrip strength and falls. Results: A total of 170 patients were included, median age was 75.5 (70-88) years and 65.9% were male. The frequency of frailty varied from 14% to 74% according to the chosen frailty tool. In multivariate analysis G814 predicted OS (HR 1.5; 95%CI 1.0-2.4), whereas G811 predicted PD (