Which are the most useful geriatric assessment screening tools in oncology?

Cancer care

By Mardi Chapman

11 Feb 2021

The Geriatric-8 (G8) and Vulnerable Elders Survey-13 top the list of tools useful in screening older patients with cancer who may benefit from a geriatric assessment.

A systematic review of the evidence by Australian investigators found G8 and VES-13 were the most commonly investigated of 12 screening tools.

Others included the Abbreviated Comprehensive Geriatric Assessment, Fried Frailty Criteria, Groningen Frailty Indicator and Physical Performance test.

The review, published in JAMA Oncology, found the G8 had higher sensitivity for geriatric vulnerabilities while the patient-administered VES-13 had high specificity.

In comparative studies, G8 sensitivity was 73.0%-81.1% compared to the VES-13 (46.0%-69.0%). Their respective specificity ranges were 44.0%-80.0% and 70.0%-100%.

The investigators, from the Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT) team, said geriatric assessments can assist with prioritising and planning treatment and care goals and preferences.

“However, the feasibility of conducting geriatric assessment on all older adults with cancer is limited by time commitment and workforce availability. Thus, a degree of specificity is not a necessity but would be beneficial for managing finite resources, including specialist expertise.”

They said one of the studies had evaluated a combination of G8 and VES-13. While showing some promise as a combined score, it could not yet be recommended.

The review also noted that few studies reported metrics such as time taken to complete screening or readability in self-administered tools.

“Such metrics may be helpful in investigating whether educational level or ease of use in screening tools can affect variability in their responses and subsequent accuracy, as well as to optimise accessibility to referral to geriatric assessment.”

They said future screening tools could potentially be tailored to specific issues.

“Regardless of setting or intent, screening tools should always be followed by a clinical response, such as a more in-depth assessment or proceeding with recommended treatment and appropriate management to address unmet needs.”

“Further research is needed to identify whether there is merit to using tools specifically for certain cancers and/or in certain clinical settings or to target certain domains.”

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