IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, Australia.
Eastern Health Clinical School, Monash University, Melbourne, Australia.
JAMA Oncol. 2021 Apr 1;7(4):616-627. doi: 10.1001/jamaoncol.2020.6736.
Older adults with cancer are at risk of overtreatment or undertreatment when decision-making is based solely on chronological age. Although a geriatric assessment is recommended to inform care, the time and expertise required limit its feasibility for all patients. Screening tools offer the potential to identify those who will benefit most from a geriatric assessment. Consensus about the optimal tool to use is lacking.
To appraise the evidence on screening tools used for older adults with cancer and identify an optimal screening tool for older adults with cancer who may benefit from geriatric assessment.
Systematic review of 4 databases (MEDLINE, Embase, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and PubMed) with narrative synthesis from January 1, 2000, to March 14, 2019. Studies reporting on the diagnostic accuracy and use of validated screening tools to identify older adults with cancer who need a geriatric assessment were eligible for inclusion. Data were analyzed from March 14, 2019, to March 23, 2020.
Seventeen unique studies were included, reporting on the use of 12 screening tools. Most studies were prospective cohort studies (n = 11) with only 1 randomized clinical trial. Not all studies reported time taken to administer the screening tools. The Geriatric-8 (G8) (n = 12) and the Vulnerable Elders Survey-13 (VES-13) (n = 9) were the most frequently evaluated screening tools. The G8 scored better in sensitivity and the VES-13 in specificity. Other screening tools evaluated include the Groningen Frailty Index, abbreviated comprehensive geriatric assessment, and Physical Performance Test in 2 studies each. All other screening tools were evaluated in 1 study each.
To date, the G8 and VES-13 have the most evidence to recommend their use to inform the need for geriatric assessment. When choosing a screening tool, clinicians will need to weigh the tradeoffs between sensitivity and specificity. Future research needs to further validate or improve current screening tools and explore other factors that can influence their use, such as ease of use and resourcing.
当决策仅基于年龄时，癌症老年患者可能会面临过度治疗或治疗不足的风险。虽然建议进行老年评估以提供治疗信息，但由于所需的时间和专业知识，并非所有患者都可行。筛查工具提供了识别最受益于老年评估的患者的潜力。目前缺乏关于最佳工具的共识。
评估用于癌症老年患者的筛查工具的证据，并确定一种可用于需要老年评估的癌症老年患者的最佳筛查工具。
系统检索了 4 个数据库（MEDLINE、Embase、CINAHL[护理和联合健康文献累积索引]和 PubMed），从 2000 年 1 月 1 日至 2019 年 3 月 14 日进行了叙述性综合分析。符合纳入标准的研究报告了用于识别需要老年评估的癌症老年患者的经过验证的筛查工具的诊断准确性和使用情况。数据分析时间为 2019 年 3 月 14 日至 2020 年 3 月 23 日。
纳入了 17 项独特的研究，报告了 12 种筛查工具的使用情况。大多数研究为前瞻性队列研究（n=11），仅有 1 项随机临床试验。并非所有研究都报告了筛查工具的使用时间。最常评估的筛查工具是老年 8 项（G8）（n=12）和脆弱性老年人调查 13 项（VES-13）（n=9）。G8 在敏感性方面得分更高，而 VES-13 在特异性方面得分更高。其他评估的筛查工具包括 2 项研究中的格罗宁根虚弱指数、简明全面老年评估和体能测试，而其他筛查工具则在 1 项研究中进行了评估。
迄今为止，G8 和 VES-13 具有最多的证据推荐用于告知老年评估的需求。在选择筛查工具时，临床医生需要权衡敏感性和特异性之间的权衡。未来的研究需要进一步验证或改进现有的筛查工具，并探索可能影响其使用的其他因素，例如易用性和资源。
