Can the short screening test Vulnerable Elders Survey 13 (VES-13) substitute for the time-consuming comprehensive geriatric assessment (CGA) to identify vulnerable/frail elderly breast cancer patients?

Abstract

9114 Background: The aim of this prospective, double-blind study was to evaluate sensitivity, specificity, positive and negative predictive values of VES-13, a 13-item function-based self-report questionnaire, as a rapid tool to uncover vulnerability/frailty compared with full CGA. Methods: All consecutive breast cancer patients aged ≥70 years referred from April 2008 to January 2010 to our medical oncology division underwent both CGA and VES-13. Tests were performed by two different investigator groups, not interchangeable and reciprocally blinded. A final score of 3 or more at the VES-13 was considered as predictive for vulnerability/frailty. At CGA patients were divided into fit, vulnerable and frail (Balducci et al Oncology 2000). Results: 150 patients entered the study, median age 76 years (range 70-94). One hundred twenty-five patients (83.3%) presented with early disease. Ninety-five patients (63.3%) were able to complete VES-13 autonomously, 8 patients (5.3%) required help while in 47 cases (31.4%) the questionnaire was completely administered by a research nurse. With CGA, 84 patients were fit (56.0%), 66 were vulnerable/frail (44%). The median time to perform VES-13 was 4 minutes (range 2-12) compared to 29 minutes (range 11-65) for CGA. Twenty five point nine percent of elderly patients with favourable VES-13 score were vulnerable/frail at full CGA while 34.8% of patients with unfavourable VES-13 were fit, the negative and positive predictive values being 74.1% and 65.2%, respectively. Sensibility and specificity of VES-13 to uncover vulnerability/frailty at full CGA were 68% and 71%, respectively. Conclusions: One third of elderly breast cancer patients had significant troubles in self-compiling the questionnaire. VES-13 significantly reduced the time of geriatric assessment, but sensitivity and specificity were unsatisfactory. Caution should be recommended in using VES-13 as a substitute for full CGA in both everyday practice and clinical trials. No significant financial relationships to disclose.