Princess Margaret Cancer Centre, University Health Network, Department of Medical Oncology and Hematology, 610 University Avenue, Toronto M5G 2M9, Ontario, Canada.
University Health Network, Department of Medicine, 200 Elizabeth Street, Toronto M5G 2C4, Ontario, Canada.
J Geriatr Oncol. 2018 Nov;9(6):683-686. doi: 10.1016/j.jgo.2018.03.001. Epub 2018 Mar 12.
Screening tools in geriatric oncology have traditionally been studied for their ability to identify patients who have abnormal domains on a comprehensive geriatric assessment (CGA). However, an alternative outcome of identifying patients who would receive CGA-based interventions could improve selection of patients whose management will be altered by a CGA. The objective of this study was to assess the performance of three geriatric oncology screening tools for their ability to predict for CGA-based interventions.
G8, Vulnerable Elders Survey (VES-13) and a modified frailty phenotype (mFP) screening tools were collected prospectively for patients enrolled in a phase II trial of geriatric evaluation and management. Interventions were defined as a new clinical diagnosis, change in management of a comorbidity, or referral to an allied health professional. Performance characteristics were calculated for each screening tool based on the outcomes of ≥2 abnormal CGA-domains and ≥1 CGA-based interventions.
Discordance between the outcomes was seen in 31.9% of patients. Using the outcome of ≥2 abnormal CGA-domains, the G8 was most sensitive at 0.73 while VES-13 and mFP were both 1.0 specific. Using the outcome of CGA-based interventions the most sensitive tool was still the G8 at 0.64 and the most specific was the mFP at 0.80.
All screening tests' performance characteristics for the G8, VES-13 and mFP were lower for the outcome of CGA-based interventions than for the traditional outcome of abnormal CGA-domains. Significant discordance between the outcomes highlights the difficulty with trying to predict which patients will truly benefit from a CGA.
老年肿瘤学的筛查工具传统上是通过其识别综合老年评估（CGA）异常域的能力进行研究的。然而，识别可能接受基于 CGA 的干预的患者的另一个结果可以改善选择将通过 CGA 改变管理的患者的选择。本研究的目的是评估三种老年肿瘤学筛查工具识别基于 CGA 的干预的能力。
前瞻性收集 G8、脆弱老年人调查（VES-13）和改良衰弱表型（mFP）筛查工具，用于参加老年评估和管理 II 期试验的患者。干预措施定义为新的临床诊断、共病管理的改变或向联合健康专业人员转诊。根据≥2 个异常 CGA 域和≥1 个基于 CGA 的干预的结果，为每个筛查工具计算性能特征。
在 31.9%的患者中观察到结果不一致。使用≥2 个异常 CGA 域的结果，G8 的灵敏度最高，为 0.73，而 VES-13 和 mFP 的特异性均为 1.0。使用基于 CGA 的干预的结果，最敏感的工具仍然是 G8，灵敏度为 0.64，最特异的是 mFP，特异性为 0.80。
G8、VES-13 和 mFP 的所有筛查测试的性能特征对于基于 CGA 的干预的结果都低于异常 CGA 域的传统结果。结果之间的显著差异突出了试图预测哪些患者将真正受益于 CGA 的困难。
