Abstract
BackgroundGeriatric screening tools are increasingly implemented in daily practice, especially in the oncology setting, but also in primary care in some countries such as the Netherlands. Nonetheless, validation of these tools regarding their ability to predict relevant outcomes is lacking. In this study we evaluate if geriatric screening tools predict decline in functional status and quality of life after one year, in a population of older cancer patients and an older primary care population without cancer with a life expectancy of at least six months.MethodsOlder cancer patients and a general older primary care population without a history of cancer (≥70 years) were included in an on-going prospective cohort study. Data were collected at baseline and after one-year follow-up. Functional decline was based on the Katz Index and Lawton IADL-scale and was defined as deterioration on one or more domains. Decline in quality of life was measured using the global health related subscale of the EORTC QLQ-C30, and was defined as a decline ≥10 points. The selected geriatric screening tools were the abbreviated Comprehensive Geriatric Assessment, Groningen Frailty Indicator, Vulnerable Elders Survey-13, and G8. We calculated sensitivity, specificity, predictive values, and odds ratios to assess if normal versus abnormal scores predict functional decline and decline in quality of life.ResultsOne-year follow-up data were available for 134 older cancer patients and 220 persons without cancer. Abnormal scores of all screening tools were significantly associated with functional decline. However, this was only true for older persons without cancer, and only in univariate analyses. For functional decline, sensitivity ranged from 54% to 71% and specificity from 33% to 66%. For decline in quality of life, sensitivity ranged from 40% to 67% and specificity from 37% to 54%.ConclusionIn older persons with a relatively good prognosis, geriatric screening tools are of limited use in identifying persons at risk for decline in functional status or quality of life after one year. Hence, a geriatric screening tool cannot be relied on in isolation, but they do provide very valuable information and may prompt physicians to also consider different aspects of functioning.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0241-x) contains supplementary material, which is available to authorized users.
Highlights
Geriatric screening tools are increasingly implemented in daily practice, especially in the oncology setting, and in primary care in some countries such as the Netherlands
We aim to evaluate the predictive value of these tools in a general older primary care population without a history of cancer, because functional decline and decline in Quality of Life (QoL) are relevant outcomes in this population and geriatric screening tools are increasingly being implemented in primary care [17,18]
The prevalence of abnormal scores was comparable in persons with and without cancer for all screening tools except for the abbreviated Comprehensive Geriatric Assessment (aCGA) (p < 0.04)
Summary
Geriatric screening tools are increasingly implemented in daily practice, especially in the oncology setting, and in primary care in some countries such as the Netherlands. In this study we evaluate if geriatric screening tools predict decline in functional status and quality of life after one year, in a population of older cancer patients and an older primary care population without cancer with a life expectancy of at least six months. One’s global health status and reserve capacities are best estimated by a geriatric assessment, which has been defined as a multidisciplinary evaluation of an older individual’s functional status, comorbidity, cognition, psychological status, social support, nutritional status and review of the patient’s medications [4,5]. Oncologists want to answer the following questions: what is the life expectancy of this patient; will the tumour influence overall survival and Quality of Life (QoL), or are other competing causes of death/disability of more importance? For generalists, such as general practitioners (GPs), the rationale behind a geriatric assessment is to assess how illness impacts functioning and what the social and medical needs are in order to develop a plan for treatment and follow-up, to manage the problems that were identified, and to prevent dependency [7]
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