Consistency and stability of vulnerable elders survey 13 (VES-13) scores in a sample of older patients treated for non-Hodgkin lymphoma

Abstract

Introduction: The Vulnerable Elders Survey (VES-13) is a simplified tool used to track the elderly at risk of deteriorating health or death. Studies in different countries have established their validity and feasibility as a tool for screening vulnerable patients in oncology. Recently we performed the cross-cultural adaptation of the instrument for use in the Brazilian population. Objectives: To evaluate the consistency and stability of VES-13 scores in a sample of cancer patients. Methods: These are the preliminary results of a cross-sectional study being developed in a cancer referral hospital in Rio de Janeiro, Brazil. Patients were interviewed using a questionnaire containing sociodemographic and clinical variables and underwent a Comprehensive Geriatric Assessment, contemplating 7domains; functionality (Activities of Daily Living-ADL and Instrumental Activities of Daily LivingIADL, emotions (Geriatric Depression Scale 15-GDS), cognition (Mini-Mental State Examination-MMSE), comorbidities (Cumulative Illness Rating Scale-CIRSG), nutrition (Mini Nutritional Assessment-MNA) and number of medications. A descriptive analysis of the study population was performed thorough frequency distributions. To evaluate the consistency and stability of f VES-13 scores in relation to those of the AGM and of the other instruments, we estimated the intraclass correlation coefficients and the respective 95% confidence intervals. Results: The study population consisted of 77 patients, equally distributed in terms of gender. Of those, 68 (88.3%) were independent in ADL and 42 (54.5%) in IADL; themajority had no cognitive impairment nor depressive symptoms, 33 (42.9%) were not at nutritional risk. Only 9 (11.7%) had severe comorbidities and 22. 1% (17) used 4 or more medications. According to VES-13, 24 (31.2%) where classified as vulnerable and 53 (68.8) as fit. Meanwhile, CGA considered 41 (53.2) individuals as fit and 36(46.8) as unfit. The comparison of VES-13 scores to those of the CGA indicated an ICC of 0.774 (95% CI 0,476-0,749). VES 13 scores also showed good stability when compared to the scores of specific instruments, with the exception of CIRSG,whose ICC presented a wide 95% confidence interval. Conclusion: This study showed good consistency and stability between VES-13 and CGA scores and the scores of the specific instrument analysed, with the exception of CIRSG. This problem, possibly, arose from the fact that we used only the most simple form of classification derived from CIRSG (number of categories endorsed) and not the scores based on severity. Based on the results for this sample, the VES-13 could be used as a screening test for the identification of vulnerable patients that would need a more comprehensive evaluation.