Daniel W Yokom1, Shabbir M H Alibhai2, Schroder Sattar3, Monika K Krzyzanowska1, Martine T E Puts4. 1. Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, 610 University Avenue, Toronto M5G 2M9, Ontario, Canada. 2. University Health Network, Department of Medicine, 200 Elizabeth Street, Toronto M5G 2C4, Ontario, Canada. 3. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto M5T 1P8, Ontario, Canada. 4. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto M5T 1P8, Ontario, Canada. Electronic address: martine.puts@utoronto.ca.
Abstract
INTRODUCTION: Screening tools in geriatric oncology have traditionally been studied for their ability to identify patients who have abnormal domains on a comprehensive geriatric assessment (CGA). However, an alternative outcome of identifying patients who would receive CGA-based interventions could improve selection of patients whose management will be altered by a CGA. The objective of this study was to assess the performance of three geriatric oncology screening tools for their ability to predict for CGA-based interventions. MATERIALS AND METHODS: G8, Vulnerable Elders Survey (VES-13) and a modified frailty phenotype (mFP) screening tools were collected prospectively for patients enrolled in a phase II trial of geriatric evaluation and management. Interventions were defined as a new clinical diagnosis, change in management of a comorbidity, or referral to an allied health professional. Performance characteristics were calculated for each screening tool based on the outcomes of ≥2 abnormal CGA-domains and ≥1 CGA-based interventions. RESULTS: Discordance between the outcomes was seen in 31.9% of patients. Using the outcome of ≥2 abnormal CGA-domains, the G8 was most sensitive at 0.73 while VES-13 and mFP were both 1.0 specific. Using the outcome of CGA-based interventions the most sensitive tool was still the G8 at 0.64 and the most specific was the mFP at 0.80. DISCUSSION: All screening tests' performance characteristics for the G8, VES-13 and mFP were lower for the outcome of CGA-based interventions than for the traditional outcome of abnormal CGA-domains. Significant discordance between the outcomes highlights the difficulty with trying to predict which patients will truly benefit from a CGA.
RCT Entities:
INTRODUCTION: Screening tools in geriatric oncology have traditionally been studied for their ability to identify patients who have abnormal domains on a comprehensive geriatric assessment (CGA). However, an alternative outcome of identifying patients who would receive CGA-based interventions could improve selection of patients whose management will be altered by a CGA. The objective of this study was to assess the performance of three geriatric oncology screening tools for their ability to predict for CGA-based interventions. MATERIALS AND METHODS: G8, Vulnerable Elders Survey (VES-13) and a modified frailty phenotype (mFP) screening tools were collected prospectively for patients enrolled in a phase II trial of geriatric evaluation and management. Interventions were defined as a new clinical diagnosis, change in management of a comorbidity, or referral to an allied health professional. Performance characteristics were calculated for each screening tool based on the outcomes of ≥2 abnormal CGA-domains and ≥1 CGA-based interventions. RESULTS: Discordance between the outcomes was seen in 31.9% of patients. Using the outcome of ≥2 abnormal CGA-domains, the G8 was most sensitive at 0.73 while VES-13 and mFP were both 1.0 specific. Using the outcome of CGA-based interventions the most sensitive tool was still the G8 at 0.64 and the most specific was the mFP at 0.80. DISCUSSION: All screening tests' performance characteristics for the G8, VES-13 and mFP were lower for the outcome of CGA-based interventions than for the traditional outcome of abnormal CGA-domains. Significant discordance between the outcomes highlights the difficulty with trying to predict which patients will truly benefit from a CGA.
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