Validation of a screening test for elderly patients in oncology

Abstract

20568 Background: Treatment-related toxicity risk increases with age and may even lead to toxic death. Detailed evaluation of patient’s status becomes mandatory. Comprehensive Geriatric assessment (CGA) is an adequate method to evaluate these patients but it is probably not necessary to all patients so that a screening tool should be developed. Methods: In a prospective multicentric cohort, we studied patients older than 70 with cancer and first-line chemotherapy. 364 patients were evaluated with the following CGA tools: MMS, ADL, IADL, MNA, Get up and go, GDS15, CIRSG, QLQ-C30. The data collected allowed us to perform an exploratory study in order to design a screening tool. Results: Analysis of this cohort allowed us to propose a new screening tool (generic name : G8), which included 7 MNA items (A, B, C, E, F, H, P) and age (<80, 80–85, >85), for a total score ranging from 0 (poor score) to 17 (good score). First, geriatrists and oncologists selected these specific items since they were expected to correlate with different dimensions of CGA. Indeed, we observed the following correlations: A (appetite), B (weight loss) and F (BMI) with total MNA score; E (cognition and depression) with MMS; C (motricity) and P (self-related health) with ADL; C with Get up and go; E and P with GDS15; H (medications) with CIRS-G. Next, we applied this new tool to our population of 364 patients. Results suggested that the area under the curve was maximized when the threshold was 14, equivalent to a 90% sensitivity, and a 60% specificity. Conclusions: This exploratory study allowed us to propose the G8 questionnaire as a screening tool for CGA. In collaboration with 15 geriatric French cancer units, we are now conducting a large prospective study (1500 patients) sponsored by the French National Cancer Institute in order to validate the G8 screening tool, as well as the VES-13 questionnaire, using the CGA as the gold- standard. Sponsored by PHRC, sanofi-aventis, AMGEN, Pfizer Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen, Pfizer Oncology, sanofi-aventis