How to identify older cancer patients who should benefit from comprehensive geriatric assessment?

Luce, Stephen B.; Breucker, Sandra De; Gossum, A. Van; Demols, A.; Mekinda, Z.; Ena, Graziella; Maerevoet, Marie; Bailly, Benjamin; Roumeguère, Thierry; Ghanooni, Rose; Nouwynck, Claire; Laethem, Jean Luc Van; Sokolow, Youri; Simon, Patricia; Bron, Dominique; Vervaet, Catherine; Marchand, Marie; Pepersack, Thierry

doi:10.1016/j.jgo.2012.10.084

Cited by 3 publications

(3 citation statements)

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“…A GA is time-consuming and resource intensive, which is one of the recognised barriers in the more widespread implementation of geriatric oncology. To mitigate this, a number of studies have been conducted, focussing on screening tools that may be used to distinguish fit older patients who are able to tolerate standard treatment versus those who may be considered more vulnerable or frail (Rodin & Mohile 2007;Bellera et al 2012;Luce et al 2012;Huisman et al 2014). The majority of the expert panel felt that screening should be implemented, but were divided approximately 50:50 between those who would recommend a particular screening tool versus those who could not identify an appropriate choice.…”

Section: Discussionmentioning

confidence: 99%

Expert consensus panel guidelines on geriatric assessment in oncology

2015

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Introduction Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. Methods A four round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations in order to gain consensus on a given topic Results Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cutoff for assessment represented a higher degree of disagreement. Discussion The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients.

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Section: Discussionmentioning

confidence: 99%

Expert consensus panel guidelines on geriatric assessment in oncology

2015

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“…Various other studies have determined sensitivities of the G8 in identifying frailty based on the CGA ranging from 65% to 92%, with the majority reporting it as greater than 80%, and specificity ranging from 40% to 75%. [31][32][33][34] The abbreviated CGA (aCGA) was also developed for use in geriatric oncology as a screening tool to identify those in need of formal assessment. 35 As opposed to the G8, the aCGA was highly specific (97%) at the expense of poor sensitivity (51%), which is the compromise frequently observed when instruments are used for this purpose.…”

Section: Diagnosis Of Frailtymentioning

confidence: 99%

Frailty in geriatric head and neck cancer: A contemporary review

et al. 2018

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Objective To provide a summary of the current frailty literature relating to head and neck cancer. Data Sources Ovid MEDLINE, PubMed, Google Scholar. Methods A comprehensive review of the literature was performed from 2000 to 2017 using key words frailty, elderly, geriatric, surgery, otolaryngology, head and neck cancer. Results The aging population has led to an increased diagnosis of head and neck cancer in elderly patients. The prevalence of comorbidities, disabilities, geriatric syndromes and social issues can make treatment planning and management in this population challenging. Chronological age alone may not be the optimal approach to guiding treatment decisions, as there is marked heterogeneity amongst this age group. Individualization of treatment can be achieved by assessing for the presence of frailty, which has growing evidence as an important marker of health status in geriatric oncology. Frailty is a complex geriatric syndrome characterized by a state of increased vulnerability to stressors and is associated with morbidity, mortality, and treatment toxicity. Screening for frailty may provide an efficient method to identify those who would benefit from further assessment or pretreatment optimization, and to provide prognostic information to assist clinicians and patients in formulating the most ideal treatment plan for the elderly individual with head and neck cancer. Conclusions Frailty has emerged as an important concept in geriatric oncology, with wide significance in head and neck cancer. Incorporating frailty assessments into clinical practice may provide otolaryngologists pertinent information regarding health status and outcomes leading to optimal care of the elderly cancer patient. Laryngoscope, 128:E416–E424, 2018

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“…Four of the 26 FSTs that were identified by the literature review included the required domains: The Geriatric‐8 (G8), the modified Geriatric‐8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool 19–22,45 . The G8 is the most extensively studied tool with appropriate measurement properties when compared to a full GA 10–13,19,48,50–65 . In the few articles studying the recently developed mG8, sensitivity (89–92%) and specificity (36–79%) for geriatric impairments detected by GA appear higher than the original G8 20,61 .…”

Section: Discussionmentioning

confidence: 99%

Frailty screening in dermato‐oncology practice: a modified Delphi study and a systematic review of the literature

Winden

Garcovich

Peris

et al. 2020

Acad Dermatol Venereol

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Background Appropriate management and prevention of both under-and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato-oncology care, since frailty is associated with adverse health outcomes. Objectives This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato-oncology practice and to select the best existing FST(s) for this purpose. Methods A modified two-round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5-point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure. Results Consensus was achieved on evaluation of comorbidities (4.3 AE 0.7), polypharmacy (4.0 AE 0.9) and cognition (4.1 AE 0.8). The FST should have appropriate measurement properties (4.0 AE 1.0), be quickly executed (4.2 AE 0.7), clinically relevant (4.3 AE 0.7), and both easily understandable (4.1 AE 1.2) and interpretable (4.3 AE 0.7). Of the 26 identified FSTs, four evaluated the content-related domains: the Geriatric-8 (G8), the modified Geriatric-8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min. Conclusions The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato-oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.

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How to identify older cancer patients who should benefit from comprehensive geriatric assessment?

Cited by 3 publications

References 0 publications

Expert consensus panel guidelines on geriatric assessment in oncology

Expert consensus panel guidelines on geriatric assessment in oncology

Frailty in geriatric head and neck cancer: A contemporary review

Frailty screening in dermato‐oncology practice: a modified Delphi study and a systematic review of the literature

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