Development of 3-item questionnaire for preoperative evaluation of older cancer patients.

Abstract

e21543 Background: Our study aims at developing a very short screening questionnaire for the preoperative evaluation of older cancer patients in the surgical clinics. Methods: Our study was based on 47-item electronic Rapid Fitness Assessment (eRFA) data presented last year (Shahrokni, et al. (J Clin Oncol 34, 2016 (suppl; abstr 10011). Frail patients were defined as having any of these criteria: Cognitive impairment (Mini-Cog < 3), basic or instrumental activities of daily living dependency, Karnofsky Performance Score ≤80, occurrence of fall in the past year, high level of distress (distress thermometer score ≥7), or Timed Up and Go test ≥ 10 seconds. The dataset was split 2/3 for training set and 1/3 for validation set. The sets were matched based on age and gender. Decision Curve Analysis (DCA) was preformed to assess the clinical utility of different models. Results: Based on a dataset of 1076 older cancer patients who completed the eRFA for preoperative evaluation in the geriatrics clinic, five models of 3 or 4-items showed to have the highest accuracy ( > 78%). For example, one 3-item questionnaire (difficulty with bladder and bowel control, fall in the past year, limitation of walking outside home) was able to identify 100% of non-frail patients and 73% of frail patients. If we use this model in the surgical clinic with a presumed 36% incidence of frailty among 1000 potential patients, the model can correctly indentify 266 out of 363 frail patients and all 637 fit patients who may and may not benefit from referral to geriatrics clinic, respectively. Using the validation set, the sensitivity and specificity of the model remained high and we confirmed the utility of the 3-item questionnaire on decision analysis. Conclusions: We identified a 3-item questionnaire to be used as a screening tool to identify frail and fit older cancer patients. Implementation of the tool is needed to evaluate whether it is useful in distinguishing older cancer patient in surgical clinic for geriatric referral. If effective, further studies should look into correlation between this questionnaire and surgical outcomes.