Screening for Vulnerability in Older Cancer Patients: The ONCODAGE Prospective Multicenter Cohort Study

Abstract

BackgroundGeriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13).Patients and MethodsThe diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate.ResultsPatient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P = 0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, P<0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival.ConclusionWith good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy.

Prognostic role of a comprehensive geriatric assessment on the management of elderly patients with advanced non-small cell lung cancer (NSCLC): a pooled analysis of two prospective phase II trials by the GFPC Group

“…These results confirm that PS is a major prognostic factor for OS in lung cancer, as in other malignancies. The role of PS in this setting was recently confirmed in a large French prospective cohort study (20). As in other advanced cancers (21,22), the number of co-morbidities is also significantly associated with OS in advanced-stage NSCLC.…”

“…It would be prudent to prioritise those tools with the best sensitivity (albeit less specific) and those with which physicians are familiar. With good sensitivity and independent prognostic value for 1-year survival, the G8 questionnaire (20) is currently one of the best screening tools for identifying older cancer patients requiring geriatric assessment, and we believe it should be broadly implemented in daily practice. Research must continue to refine the selection of older cancer patients for potentially life-threatening therapy (20,28).…”

Utility of the Edmonton Frail Scale in identifying frail elderly patients during treatment of colorectal cancer

“…The Vulnerable Elder Survey (VES-13) did correlate with a CGA in a pilot study of 50 patients with metastatic prostate cancer, as well as more diverse population of hematological and solid malignancies (21,22). The G8 instrument has been developed by the ONCODAGE project in France, and there are comparative data against the VES-13 suggests better sensitivity (23). A recent systematic review found that both the VES-13, and G8 (along with other instruments) did not have sufficient discrimination ability to replace the CGA (24).…”

What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

“…An abnormal G8, VES-13, and Triage Risk Screening Tool have been associated with functional decline and poorer survival. 60,61,70 The Groningen Frailty Index has also been associated with worse survival. 46,71 Thus, it may not be unreasonable to consider performing a geriatric screen even in those centers in which a subsequent full geriatric assessment would not be possible.…”