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PLoS One. 2014 Dec 11;9(12):e115060. doi: 10.1371/journal.pone.0115060. eCollection 2014.

Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study.

Author information

1
Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; University of Bordeaux, Bordeaux, France.
2
Clinical and Epidemiological Research unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; INSERM U897 (Institut national de la santé et de la recherche médicale), CIC1401 (Centre d'investigation clinique), Institut Bergonié, Bordeaux, France.
3
Oncogeriatric Coordination unit, Centre Jean Perrin, Clermont-Ferrand, France.
4
Oncology and Hematology unit, Centre Hospitalier Universitaire de Strasbourg - Hôpital de Hautepierre, Strasbourg, France.
5
Geriatric unit, Institut Jean Godinot, Reims, France.
6
Cancer Support unit, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France.
7
Geriatric Evaluation and Management unit, Antoine Charial Hospital, Francheville, Lyon, France.
8
Breast Cancer unit, Centre Oscar Lambret, Lille, France.
9
Internal Medicine unit, Hôpital européen Georges-Pompidou, Paris, France.
10
Surgical Oncology unit, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France.
11
Medical Oncology unit, Centre Léon Bérard, Lyon, France.
12
Senology unit, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France.
13
Oncology and Haematology unit, Centre Hospitalier Départemental, La Roche sur Yon, France.
14
Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; Department of Clinical Gerontology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
15
University of Bordeaux, Bordeaux, France; Clinical and Epidemiological Research unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; INSERM U897 (Institut national de la santé et de la recherche médicale), CIC1401 (Centre d'investigation clinique), Institut Bergonié, Bordeaux, France.
16
University of Bordeaux, Bordeaux, France; Department of Clinical Gerontology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.

Abstract

BACKGROUND:

Geriatric 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 METHODS:

The 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.

RESULTS:

Patient 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.

CONCLUSION:

With 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.

PMID:
25503576
PMCID:
PMC4263738
DOI:
10.1371/journal.pone.0115060
[Indexed for MEDLINE]
Free PMC Article

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