Geriatric 8 Scale to Predict Functional Decline in Older Adults With Cancer: a Systematic Review (original) (raw)
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Journal of Geriatric Oncology, 2021
Most adults with cancer are over 65 years of age, and this cohort is expected to grow exponentially. Older adults have an increased burden of comorbidities and risk of experiencing adverse events on anticancer treatments, including functional decline. Functional impairment is a predictor of increased risk of chemotherapy toxicity and shorter survival in this population. Healthcare professionals caring for older adults with cancer should be familiar with the concept of functional status and its implications because of the significant interplay between function, cancer, anticancer treatments, and patient-reported outcomes. In this narrative review, we provide an overview of functional status among older patients with cancer including predictors, screening, and assessment tools. We also discuss the impact of functional impairment on patient outcomes, and describe the role of individual members of an interprofessional team in addressing functional impairment in this population, including the use of a collaborative approach aiming to preserve function.
The Lancet Healthy Longevity, 2021
Background Functional assessment of patients with cancer can be challenging and is often undertaken by the clinician with minimal direct input from the patient. We developed and aimed to validate the Elderly Functional Index (ELFI), a composite measure of self-reported functioning in older patients with cancer. Methods In this multicentre, prospective validation study, we validated ELFI in adult patients attending five oncology practices in Australia. ELFI is a 12-item composite measure of self-reported functioning derived from functional scales of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ): physical, role, and social functioning, and mobility. For evaluation of validity and internal consistency, participants self-completed ELFI, cognitive functioning and emotional functioning scales of the EORTC QLQ Core-30, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), instrumental activities of daily living (IADL), and Clinical Frailty Scale (CFS) at baseline. For evaluation of test-retest reliability, participants opted in to repeat ELFI, cognitive functioning scale, emotional functioning scale, and ECOG-PS 1 week later, as well as completing the Global Rating of Change. Internal consistency reliability was assessed using Cronbach's α and test-retest reliability was assessed using intraclass correlation (ICC). We assessed ELFI for convergent and discriminant validity (Spearman's r), known-groups validity (ANOVA), and structural validity (exploratory factor analysis). Findings Between May 6 and Dec 15, 2017, 877 participants with cancer returned a total of 869 baseline questionnaires and 482 retest questionnaires. 621 (71%) participants (192 [31%] aged ≥70 years) were included in evaluations of validity and internal consistency and 278 (32%) participants (106 [38%] aged ≥70 years) in evaluations of test-retest reliability. ELFI demonstrated excellent internal consistency reliability (Cronbach's α=0•93 for all participants; p<0•0001) and test-retest reliability (overall ICC 0•90, 95% CI 0•87-0•92; p<0•0001). Hypotheses regarding convergent and discriminant validity were confirmed, with all item-scale correlations exceeding 0•40 except for one on the physical functioning scale. ELFI was better than its component scales and other function measures at differentiating between groups with different function and frailty scores (known-groups validity). Exploratory factor analysis provided empirical support to the structural validity of ELFI. Strong correlation was observed between ELFI and its component scales (r ranging from 0•67 to 0•79), ECOG-PS (-0•79), IADL (0•69), and CFS (-0•73). Interpretation ELFI is a validated and simple person-reported multidimensional measure of functional status, which captures broad dimensions of functioning. ELFI has enhanced statistical efficiency relative to its components, reducing the sample size required to detect a given effect. ELFI could be used as a clinical trial endpoint to assess functional domains of health-related quality of life.
Comprehensive Geriatric Assessment in the Older Adult with Cancer: A Review
European Urology Focus, 2017
Context: The number of older adults with cancer is expected to increase rapidly in the upcoming decades. Aging is heterogeneous and chronological age is often not reflective of biological age. A comprehensive geriatric assessment (CGA) is an in-depth assessment of multiple domains of health that results in better assessment of a patient's overall health and fitness and allows directed intervention to improve patient outcomes. Objective: To review the value of CGA for older adults with cancer, CGA composition and tools that can be utilized, and the feasibility of including CGA in oncologic practice. Evidence acquisition: The currently available evidence on CGA for older adults with cancer was reviewed. Evidence synthesis: A CGA can highlight unidentified health problems and identify patients at higher risk of mortality, functional decline, surgical complications, chemotherapy intolerance, and chemotherapy toxicity. It has been shown that CGA is feasible in the oncology clinic, but geriatric screening tools may be useful to specifically identify patients who would benefit from a full CGA. Conclusions: CGA is feasible and can identify patients at higher risk of adverse events such as mortality, functional decline, surgical complications, and chemotherapy toxicity. Clinicians should consider incorporating CGA when assessing and caring for older adults with cancer. Patient summary: In this report, we review the benefits of a comprehensive geriatric assessment (CGA), a detailed in-depth assessment that identifies health problems not typically identified during routine assessments, for older adults with cancer. We describe the different domains of the CGA and suggest tools to utilize, as well as ways to incorporate CGA into the cancer care setting.
Comprehensive geriatric assessment test in elderly cancer patients
Sudan Medical Monitor, 2015
Background: Cancer is the first cause of the death among the people with 65-75 years age, and about 60% of cancers are diagnosed at age over 70. In this study, the impact of comprehensive geriatric assessments (CGAs) on the quality and the length of life in disabled elderly cancer patients were evaluated. Patients and Methods: In an interventional study, 70 patients with cancer were randomly divided into two treatment and control groups. The patients were evaluated during a 6-month study using CGA test. Results: The patient's mean age was 4.2 ± 67.1 years. It was shown that CGA intervention had no impact on physical activity tests, including instrumental activities of daily living and activities of daily living, but a significant improvement was shown in patient's psychological status using geriatric depression test. Conclusions: The results of the current study showed that CGA interventions have a positive effect on the quality of the life of the elderly cancer patients.
Journal of Clinical Oncology, 2014
To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment-related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.
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.
Journal of Clinical Oncology, 2002
To appraise the performance of Comprehensive Geriatric Assessment (CGA) in elderly cancer patients (> 65 years) and to evaluate whether it could add further information with respect to the Eastern Cooperative Oncology Group performance status (PS). Patients and Methods: We studied 363 elderly cancer patients (195 males, 168 females; median age, 72 years) with solid (n ؍ 271) or hematologic (n ؍ 92) tumors. In addition to PS, their physical function was assessed by means of the activity of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comorbidities were categorized according to Satariano's index. The association between PS, comorbidity, and the items of the CGA was assessed by means of logistic regression analysis. Results: These 363 elderly cancer patients had a good functional and mental status: 74% had a good PS (ie, lower than 2), 86% were ADL-independent, and 52% were IADL-independent. Forty-one percent of patients had one or more comorbid conditions. Of the patients with a good PS, 13.0% had two or more comorbidities; 9.3% and 37.7% had ADL or IADL limitations, respectively. By multivariate analysis, elderly cancer patients who were ADL-dependent or IADL-dependent had a nearly twofold higher probability of having an elevated Satariano's index than independent patients. A strong association emerged between PS and CGA, with a nearly five-fold increased probability of having a poor PS (ie, > 2) recorded in patients dependent for ADL or IADL. Conclusion: The CGA adds substantial information on the functional assessment of elderly cancer patients, including patients with a good PS. The role of PS as unique marker of functional status needs to be reappraised among elderly cancer patients.
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.
BMC Geriatrics
Background Age is considered as one of the most important risk-factor for many types of solid and hematological cancers, as their incidence increases with age in parallel to the ever-growing elderly population. Moreover, cancer incidence is constantly increasing as a consequence of the increase in life expectancy that favors the process of cellular senescence. Geriatric assessment has been increasingly recognized as predictive and prognostic instrument to detect frailty in older adults with cancer. In particular, the G8 score is a simple and reproducible instrument to identify elderly patients who should undergo full geriatric evaluation. Due to their frailty, elderly patients may be often under-treated and a therapeutic choice based also on a comprehensive geriatric assessment (CGA) is recommended. With these premises, we aim to test the impact of the CGA based interventions on the quality of life (QoL) of frail elderly onco-hematological patients, identified by the G8 screening, c...