Screening older cancer patients for a Comprehensive Geriatric Assessment: A comparison of three instruments

BackgroundThe Vulnerable Elders Survey (VES-13) has been validated for screening older cancer patients for a Comprehensive Geriatric Assessment (CGA). To identify a widely acceptable approach that encourages oncologists to screen older cancer patients for a CGA, we examined the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and Karnofsky Index of Performance Status (KPS) scales' ability to identify abnormalities on a CGA and compared the performance of the two instruments with the VES-13.MethodsWe enrolled 117 participants, ≥ 65 years with stage I–IV cancer into this cross-sectional study. Our primary outcome variable was ≥ two abnormalities on the CGA, (Yes or No). We employed receiver operating characteristic curve analysis to compare the discriminatory abilities of the three instruments to identify ≥ two abnormalities on the CGA.ResultsOf the 117 participants, 43% had ≥ two abnormalities on the CGA. The VES-13 was predictive of ≥ two abnormalities on the CGA, area under the curve (AUC) = 0.85 [(95% CI: 0.78–0.92); sensitivity = 88%, specificity = 69%, at cut-off ≥ 3]. The ECOG-PS and KPS showed similar discriminatory powers, AUC = 0.88 [(95% CI: 0.83–0.94); sensitivity = 94%, specificity = 55%, at cut-off ≥ 1]; and AUC = 0.90 [(95% CI: 0.84–0.96); sensitivity = 78%, specificity = 91%, at cut-off ≤ 80%], respectively.ConclusionThe ECOG-PS and KPS were equivalent to the VES-13 in identifying older cancer patients with at least two abnormalities on the CGA. Given that oncologists are already conversant with the KPS and ECOG-PS, these two instruments offer medical oncologists a widely acceptable approach for screening older patients for a CGA.