Screening for Vulnerability in Older Cancer Patients: The ONCODAGE Prospective Multicenter Cohort Study

BackgroundGeriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13).Patients and MethodsThe diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate.ResultsPatient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P = 0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, PConclusionWith good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy.背景：老年评估（Geriatric Assessment）是识别治疗期间存在危及生命事件风险的老年癌症患者的适宜方法，但在临床实践中应用不足，主要原因在于其耗时且耗费医疗资源。本研究旨在通过对比G8量表与脆弱老年人调查量表（Vulnerable Elders Survey, VES-13）两种简短评估工具的性能，筛选出最适合识别需接受老年评估的老年癌症患者的筛查工具。患者与方法：本研究为一项前瞻性队列研究，在23家医疗机构招募了1674例治疗前癌症患者，对G8量表与VES-13的诊断准确性进行评估，其中1435例符合入组标准且可被评估。主要结局指标包括多维老年评估（multidimensional geriatric assessment, MGA）、敏感度（主要终点）、特异度、G8量表与VES-13的阴性与阳性预测值及似然比，以及1年生存率的预测因素。结果：受试者中位年龄为78.2岁（范围70~98岁），女性占比69.8%，涵盖多种癌症类型，其中乳腺癌占53.9%，体能状态（Performance Status）0~1级者占75.8%。存在多维老年评估异常、G8量表异常及VES-13异常的比例分别为80.2%、68.4%及60.2%。完成G8量表或VES-13量表的平均时长约为5分钟。两种问卷的重测信度良好。G8量表的敏感度更高（76.5% vs 68.7%，P=0.0046），而VES-13的特异度更高（74.3% vs 64.4%，P）。结论：鉴于G8量表具备良好的敏感度及对1年生存率的独立预后价值，其是目前可用于识别需接受老年评估的老年癌症患者的最佳筛查工具之一，我们认为应在临床日常实践中广泛推广应用。未来仍需持续开展研究，以优化潜在危及生命的治疗前老年癌症患者的筛选流程。