Patients in need of geriatric assessment are well stratified by the Geriatric-8 (G8) and Vulnerable Elders Survey-13 (VES-13) instruments. These findings from a systematic review were published in JAMA Oncology.
Risk of undertreatment or overtreatment is a concern when cancer treatment decisions for older adults are based solely on chronological age. In addition, performing geriatric assessment for all patients may not be feasible. Although several screening tools are available, consensus on an optimal screening tool is lacking. Therefore, this study sought to review the evidence and identify which screening tool provides the best measure of need for geriatric assessment.
Publication databases were searched through March 2019 for studies of adults a mean or median 65 years old with cancer for whom validated screening instruments were used. A total of 18 articles on 17 studies were identified. Most studies (11) were of prospective cohort designs and recruited patients from the inpatient setting (10).
A total of 12 geriatric oncology screening tools were used to assess between 6 and 9 domains. Need for geriatric assessment was defined by the studies as vulnerability in at least 1 (n=7), at least 2 (n=2), or at least 3 (n=3) domains. The most frequently utilized tools were the G8 (12 studies) and VES-13 (9 studies).
Among individual studies, the G8 had moderate to high sensitivities (range, 44.7% to 97.0%) and specificities (range, 44.0% to 100%), whereas the VES-13 had low to moderate sensitivities (range, 20.0% to 72.0%) but high specificities (range, 70.0% to 100%).
Six studies that compared the 2 instruments found G8 outperformed VES-13 with regard to sensitivity and negative predictive value and underperformed the VES-13 for specificity. Both the G8 and VES-13 instruments had similar positive predictive values (range, 44.0% to 80.0% and 67.0% to 100%, respectively).
This study was limited by the lack of consistency in their application of the assessment instruments across the studies.
These data indicated the most frequently used geriatric assessment instruments are the G8 and VES-13, and evidence supports their use to accurately stratify the need for geriatric assessment in older patients older.
Disclosures: One author declared affiliation with industry. Please refer to the original article for a full list of disclosures.
Garcia MV, Agar MR, Soo WK, To T, Phillips JL. Screening tools for identifying older adults with cancer who may benefit from a geriatric assessment: a systematic review. JAMA Oncol. Published online January 14, 2021. doi:10.1001/jamaoncol.2020.6736