title: Screening older cancer patients for a Comprehensive Geriatric Assessment: A comparison of three instruments.
abstract: BACKGROUND: The 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.  METHODS: We 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.  RESULTS: Of 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.  CONCLUSION: The 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.
authors.affiliation: Division of Hematology/Oncology, University Hospitals of Cleveland, Cleveland, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.forename: Mark
authors.initials: M
authors.lastname: Schluchter
authors.forename: Paul
authors.initials: P
authors.lastname: Bakaki
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Berger