van Winden M E C, Garcovich S, Peris K, Colloca G, de Jong E M G J, Hamaker M E, van de Kerkhof P C M, Lubeek S F K
Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.
J Eur Acad Dermatol Venereol. 2021 Jan;35(1):95-104. doi: 10.1111/jdv.16607. Epub 2020 Jul 1.
Appropriate management and prevention of both under- and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato-oncology care, since frailty is associated with adverse health outcomes.
This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato-oncology practice and to select the best existing FST(s) for this purpose.
A modified two-round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5-point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure.
Consensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and cognition (4.1 ± 0.8). The FST should have appropriate measurement properties (4.0 ± 1.0), be quickly executed (4.2 ± 0.7), clinically relevant (4.3 ± 0.7), and both easily understandable (4.1 ± 1.2) and interpretable (4.3 ± 0.7). Of the 26 identified FSTs, four evaluated the content-related domains: the Geriatric-8 (G8), the modified Geriatric-8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min.
The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato-oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.
对老年皮肤癌患者进行适当的管理以及预防治疗不足和过度治疗都具有挑战性。在皮肤肿瘤学护理中纳入衰弱筛查可能会有所帮助，因为衰弱与不良健康结局相关。
本研究旨在确定并优先考虑衰弱筛查工具（FST）在皮肤肿瘤学实践中应满足的要求，并为此选择最佳的现有FST。
在50名意大利和荷兰的专家及患者中进行了两轮改进的德尔菲法，使用5点李克特量表对潜在的FST要求清单进行审查并确定优先级。共识定义为平均得分≥4.0。进行了系统的文献检索以识别现有的多领域FST，然后根据改进的德尔菲法得出的要求对其进行评估。
在合并症评估（4.3±0.7）、多重用药（4.0±0.9）和认知（4.1±0.8）方面达成了共识。FST应具有适当的测量属性（4.0±1.0），执行速度快（4.2±0.7），具有临床相关性（4.3±0.7），并且易于理解（4.1±1.2）和解释（4.3±0.7）。在确定的26种FST中，有四种评估了与内容相关的领域：老年8项（G8）、改良老年8项（mG8）、格罗宁根衰弱指标（GFI）和老年成人肿瘤项目2（SAOP2）筛查工具。其中，G8是研究最广泛的FST，具有最佳的心理测量属性，且能在5分钟内完成。
G8似乎是评估老年皮肤癌患者衰弱最合适的FST，不过需要进行临床研究来评估其在皮肤肿瘤学人群中的应用情况，以进一步评估在这一特定患者群体中衰弱是否与相关结局（如并发症和死亡率）相关，就像之前在其他医学领域的研究中所发现的那样。
