The discussion of age and geriatric assessment domains in oncology consultations

Abstract

problem. Unfortunately, elderly cancer patients are under-represented in clinical trials for new cancer therapies. Chronological age itself is less important than biological events in driving the aging process within an individual. There is no simple way to assess biological age, and the best tool available to date is a Comprehensive Geriatric Assessment, however it is time consuming. For this reason, alternative screening tools are being evaluated Objectives: Two proposed screening tools; the Vulnerable Elders Survey-13 (VES-13) and the G8 were compared, to identify vulnerable patients who could avoid severe toxicities if offered best supportive care. Methods: All patients aged ≥60 years attending Alexandria Clinical Oncology Department between October 2011 and March 2012 were classified into two groups; group A included patients b70 years while group B included patients N70 years and were assessed with VES-13 and G8 before starting treatment, using the translated Arabic versions for both scoring systems. Receiver operating characteristics (ROC)-analysis was used to determine the diagnostic performance of both screening instruments taking into consideration the occurrence of severe toxicities as the outcome endpoint. Decision analysis tree was plotted for the two groups. Results: 138 patients were recruited, of which 39.9% and 46.4% were defined vulnerable when evaluated with VES-13 and G8 respectively. The areas under the ROC-curves of VES-13 (0.857) and G8 (0.4451) were significantly different (P b 0.001). A sensitivity and specificity of respectively 84% and 73.3% for VES-13 (cut-off ≥3) and 68% and 36.6% for G8 (cut-off ≤14) were obtained. The optimal cut-off score of 4 for VES-13 resulted in a sensitivity of 80% and a specificity of 80%, while 10 for G8 resulted in a sensitivity of 28% and a specificity of 86.6%. The difference between G8 and VES-13 in the decision analysis was not large but VES-13 showed superiority. The decision pathway of the highest utility outcome was using VES-13 for screening and treating ‘Fit’ patients. Vulnerable patients would avoid severe complications or inadequate treatment when offered best supportive care, until a tailored tolerable effective protocol is available. TestingVES-13 ‘Vulnerable’ patientswithG8 did not add significantly to the outcome. The utility outcome for both VES-13 and G-8 scoring systems did not differ whether the cutoff scores used were those proposed in literature or the newly proposed ones. Conclusion: VES-13 screening tool showed superiority over G-8 scoring system as regards sensitivity, specificity, accuracy and also utility outcome when taking into consideration the occurrence of severe toxicity as the outcome endpoint. To the time being, the patient who becomes vulnerable by VES-13 would be better offered best supportive care or a tailored tolerable effective protocol within the context of a prospective randomized trial. Disclosure of interest: None declared.