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

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

doi:10.1016/j.jgo.2012.06.003

Cited by 16 publications

(9 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…So far, no objective arguments have been raised that enable us to choose the best threshold [35] . Selecting patients with at least one abnormal questionnaire (80% of patients in our series, 66% to 94% in other published studies) [18] , [24] , [27] , [29] reduces the risk of missing unfit patients but also limits the validity of the screening procedure. With two abnormal tests as the threshold, the target population is smaller (56.7% in our series vs. 43% to 76% in the literature) [18] , [26] , [30] – [33] , which may enable us to concentrate our efforts on the most vulnerable patients.…”

Section: Discussionmentioning

confidence: 82%

“…However, while MGA appears the best available and most reproducible instrument to identify it, this target population (reference test) has no unbiased definition. Two different thresholds considering one [18] , [24] , [27] , [29] or two [18] , [26] , [30] – [33] abnormal questionnaires have been proposed in the literature with different sets of questionnaires that more or less cover geriatric domains [34] . So far, no objective arguments have been raised that enable us to choose the best threshold [35] .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2014

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

View full text Add to dashboard Cite

show abstract

“…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 and Mohile, 2007, Luce et al, 2012, Bellera 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. In a recent systematic review (Hamaker et al, 2012), Hamaker and colleagues concluded that none of the currently available frailty screening methods have sufficient sensitivity or specificity for predicting outcome on GA.…”

Section: Discussionmentioning

confidence: 99%

Expert consensus panel guidelines on geriatric assessment in oncology

2015

View full text Add to dashboard Cite

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.

show abstract

“…Sensitivity and specificity for the G8 was 76.5% and 64.4%, respectively, and it was found to be an independent prognostic factor for 1‐year survival. 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% . The abbreviated CGA (aCGA) was also developed for use in geriatric oncology as a screening tool to identify those in need of formal assessment .…”

Section: Diagnosis Of Frailtymentioning

confidence: 99%

Frailty in geriatric head and neck cancer: A contemporary review

et al. 2018

View full text Add to dashboard Cite

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

show abstract

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

Cited by 16 publications

References 45 publications

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

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

Expert consensus panel guidelines on geriatric assessment in oncology

Frailty in geriatric head and neck cancer: A contemporary review

Contact Info

Product

Resources

About