Four screening instruments for frailty in older patients with and without cancer: a diagnostic study

Ineke H G J Smets, Gertrudis I J M Kempen, Maryska L G Janssen-Heijnen, Laura Deckx, Frank J V M Buntinx, Marjan van den Akker, Ineke H G J Smets, Gertrudis I J M Kempen, Maryska L G Janssen-Heijnen, Laura Deckx, Frank J V M Buntinx, Marjan van den Akker

Abstract

Background: Frailty in older patients might influence treatment decisions. Frailty can be determined using a Comprehensive Geriatric Assessment (CGA), but this is time-consuming and expensive. Therefore we assessed the diagnostic value of four shorter screening instruments.

Methods: We tested the abbreviated CGA (aCGA), the Vulnerable Elders Survey-13 (VES-13), the Groningen Frailty Indicator (GFI) and the Geriatric 8 (G8). A full CGA including functional status, cognitive status, depression, nutrition and comorbidity was used as reference. A minimum of 85% for both sensitivity and specificity was predefined as acceptable. Data were collected through personal interviews by trained interviewers. We assessed people aged ≥ 70 years: 108 patients with recently diagnosed cancer recruited in hospitals and 290 without cancer recruited by general practitioners in the Netherlands and Belgium.Frailty was defined as having impairment in at least two domains of the full CGA. We used original cut-offs for the screening instruments and calculated sensitivity, specificity, positive and negative diagnostic values and the percentage classified as frail.

Results: Sensitivity of aCGA was 79% and 87% for patients with and without cancer; specificity was 59% and 64%. Sensitivity of VES-13 was 67% and 82% for patients with and without cancer; specificity was 70% and 79%. Sensitivity for GFI was 76% (in both groups) and specificity 73% (in both groups). Sensitivity for G8 was 87% and 75% for patients with and without cancer; specificity was 68% (in both groups).

Conclusions: No screening instrument was acceptable according to our predefined minimum of 85% for both sensitivity and specificity. The diagnostic value of the investigated instruments is rather poor and one could wonder about their additional value to clinical judgment.

References

    1. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007;14(3):581–592.
    1. Rodin MB, Mohile SG. A practical approach to geriatric assessment in oncology. J Clin Oncol. 2007;14(14):1936–1944. doi: 10.1200/JCO.2006.10.2954.
    1. Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT, Vlastos G. Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol. 2007;14(14):1858–1869. doi: 10.1200/JCO.2006.10.4208.
    1. Janssen-Heijnen ML, Houterman S, Lemmens VE, Louwman MW, Maas HA, Coebergh JW. Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach. Crit Rev Oncol Hematol. 2005;14(3):231–240. doi: 10.1016/j.critrevonc.2005.04.008.
    1. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;14(3):255–263. doi: 10.1093/gerona/59.3.M255.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G. et al.Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;14(3):M146–M156. doi: 10.1093/gerona/56.3.M146.
    1. Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, Ershler WB, Harris T, Fried LP. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;14(6):991–1001. doi: 10.1111/j.1532-5415.2006.00745.x.
    1. Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community-living older persons. Arch Intern Med. 2006;14(4):418–423. doi: 10.1001/archinte.166.4.418.
    1. Daniels R, Metzelthin S, Van Rossum E, De Witte L, Van den Heuvel W. Interventions to prevent disability in frail community-dwelling older persons: an overview. Eur J Ageing. 2010;14:37–55. doi: 10.1007/s10433-010-0141-9.
    1. Solomon DH. Geriatric assessment: methods for clinical decision making. JAMA. 1988;14(16):2450–2452. doi: 10.1001/jama.1988.03720160070033.
    1. Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, Mor V, Monfardini S, Repetto L, Sorbye L. et al.Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG) Crit Rev Oncol Hematol. 2005;14(3):241–252. doi: 10.1016/j.critrevonc.2005.06.003.
    1. Maas HA, Janssen-Heijnen ML, Olde Rikkert MG, Machteld Wymenga AN. Comprehensive geriatric assessment and its clinical impact in oncology. Eur J Cancer. 2007;14(15):2161–2169. doi: 10.1016/j.ejca.2007.08.002.
    1. Overcash JA, Beckstead J, Extermann M, Cobb S. The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis. Crit Rev Oncol Hematol. 2005;14(2):129–136. doi: 10.1016/j.critrevonc.2004.12.002.
    1. Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, Roth C, MacLean CH, Shekelle PG, Sloss EM. et al.The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;14(12):1691–1699. doi: 10.1046/j.1532-5415.2001.49281.x.
    1. Steverink N, Slaets JPJ, Schuurmans H, Van Lis M. Measuring Frailty: development and testing of the Groningen Frailty Indicator (GFI) The Gerontologist. 2001;14:236–237.
    1. Bellera CA, Rainfray M, Mathoulin-Pelissier S, Mertens C, Delva F, Fonck M, Soubeyran PL. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;14(8):2166–2172. doi: 10.1093/annonc/mdr587.
    1. Soubeyran PL, Bellera CA, Gregoire F, Blanc J, Ceccaldi J, Blanc-Bisson C. Validation of a screening test for elderly patients in oncology. J Clin Oncol. 2008;14(20):20568.
    1. Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012;14(10):e437–e444. doi: 10.1016/S1470-2045(12)70259-0.
    1. Daniels R, van Rossum E, Beurskens A, van den Heuvel W, de Witte L. The predictive validity of three self-report screening instruments for identifying frail older people in the community. BMC Public Health. 2012;14:69. doi: 10.1186/1471-2458-12-69.
    1. Metzelthin SF, Daniels R, van Rossum E, de Witte L, van den Heuvel WJ, Kempen GI. The psychometric properties of three self-report screening instruments for identifying frail older people in the community. BMC Public Health. 2010;14:176. doi: 10.1186/1471-2458-10-176.
    1. Kellen E, Bulens P, Deckx L, Schouten H, Van Dijk M, Verdonck I, Buntinx F. Identifying an accurate pre-screening tool in geriatric oncology. Crit Rev Oncol Hematol. 2010;14(3):243–248. doi: 10.1016/j.critrevonc.2009.12.002.
    1. Hoogendijk EO, van der Horst HE, Deeg DJ, Frijters DH, Prins BA, Jansen AP, Nijpels G, van Hout HP. The identification of frail older adults in primary care: comparing the accuracy of five simple instruments. Age Ageing. 2013;14(2):262–265. doi: 10.1093/ageing/afs163.
    1. Deckx L, van Abbema D, Nelissen K, Daniels L, Stinissen P, Bulens P, Linsen L, Rummens JL, Robaeys G, de Jonge ET. et al.Study protocol of KLIMOP: a cohort study on the wellbeing of older cancer patients in Belgium and the Netherlands. BMC Public Health. 2011;14:825. doi: 10.1186/1471-2458-11-825.
    1. Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61–65.
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;14(3):179–186.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;14(3):189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;14(1):37–49. doi: 10.1016/0022-3956(82)90033-4.
    1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC. et al.The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;14(5):365–376. doi: 10.1093/jnci/85.5.365.
    1. de Graeff A, Vogel J, Jager-Wittenaar H, Chua-Hendriks J, Beijer S. Malnutrition in patients with cancer. Ned Tijdschr Geneeskd. 2012;14(38):A4911.
    1. Biganzoli L, Boni L, Becheri D, Zafarana E, Biagioni C, Cappadona S, Bianchini E, Oakman C, Magnolfi SU, Di Leo A. et al.Evaluation of the cardiovascular health study (CHS) instrument and the Vulnerable Elders Survey-13 (VES-13) in elderly cancer patients. Are we still missing the right screening tool? Ann Oncol. 2013;14(2):494–500. doi: 10.1093/annonc/mds331.
    1. Ruiz M, Reske T, Cefalu C, Estrada J. Management of Elderly and Frail Elderly Cancer Patients: The Importance of Comprehensive Geriatrics Assessment and the Need for Guidelines. Am J Med Sci. 2013;14(1):66–69. doi: 10.1097/MAJ.0b013e31826d59aa.

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