Petit-Monéger Aurélie, Rainfray Muriel, Soubeyran Pierre, Bellera Carine A, Mathoulin-Pélissier Simone
Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, 229 cours de l'Argonne, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Clinical Epidemiology and Clinical Investigation Centre CIC-1401, Clinical Epidemiology Module, F-33000 Bordeaux, France; Bordeaux University, 146 rue Léo Saignat, F-33000 Bordeaux, France.
Bordeaux University, 146 rue Léo Saignat, F-33000 Bordeaux, France; Department of Clinical Gerontology, Bordeaux University Hospital, F-33604 Pessac, France.
J Geriatr Oncol. 2016 Mar;7(2):99-107. doi: 10.1016/j.jgo.2016.01.004. Epub 2016 Feb 8.
The G8 is a screening test to identify frail elderly patients with cancer. Objectives were to design and evaluate the performance of alternative tests taking into account other predictive domains for frailty.
We conducted a literature review to identify predictive factors of frailty. Using a Delphi consensus, we collected 24 European experts' opinions to validate the most relevant items to improve the G8. Alternative tests were created and performance assessed on a development population (ONCODAGE cohort). The highest performing test was compared to the G8, and validated through both an internal and an external population validation (Aquitaine Geriatric Oncology cohort).
The study population consisted of 1435 patients (ONCODAGE cohort) and 364 patients (Aquitaine Geriatric Oncology cohort). Twenty-three experts validated two items with a strong consensus (>75%): modification of the threshold for the G8 polypharmacy item to six drugs per day and replacement of the G8 item on neuropsychological problems by four Instrumental Activities of Daily Living (IADL) items predictive of incident dementia, creating three modified G8 tests (addition of either item, or both). Only the G8 IADL-modified test had better performance than the G8 when tested on the ONCODAGE cohort: sensitivity=77%, specificity=67%. This test was validated on the internal (sensitivity=78%, specificity=71%) and external (sensitivity=88%, specificity=69%) validation populations.
Adding the four IADL items improves the performance of the G8. We have developed and validated a G8-modified test that is more specific than the G8 to detect frail elderly, while still sensitive and feasible in less than 10 min.
G8是一项用于识别体弱老年癌症患者的筛查测试。目的是设计并评估考虑到其他体弱预测领域的替代测试的性能。
我们进行了文献综述以确定体弱的预测因素。通过德尔菲共识法，我们收集了24位欧洲专家的意见，以验证与改进G8最相关的项目。创建了替代测试，并在一个开发人群（ONCODAGE队列）中评估其性能。将性能最佳的测试与G8进行比较，并通过内部和外部人群验证（阿基坦老年肿瘤学队列）进行验证。
研究人群包括1435名患者（ONCODAGE队列）和364名患者（阿基坦老年肿瘤学队列）。23位专家以强烈共识（>75%）验证了两个项目：将G8多重用药项目的阈值修改为每天6种药物，并将G8中关于神经心理问题的项目替换为4项预测新发痴呆的日常生活工具性活动（IADL）项目，从而创建了三项修改后的G8测试（添加其中一项或两项）。在ONCODAGE队列上进行测试时，只有G8 IADL修改测试的性能优于G8：敏感性=77%，特异性=67%。该测试在内部验证人群（敏感性=78%，特异性=71%）和外部验证人群（敏感性=88%，特异性=69%）中得到了验证。
添加4项IADL项目可提高G8的性能。我们已经开发并验证了一种修改后的G8测试，它在检测体弱老年人方面比G8更具特异性，同时在不到10分钟的时间内仍具有敏感性和可行性。
