Accuracy of the G-8 geriatric-oncology screening tool for identifying vulnerable elderly patients with cancer according to tumour site: the ELCAPA-02 study.
OBJECTIVE
G-8 screening tool showed good screening properties for identifying vulnerable elderly patients with cancer who would benefit from a comprehensive geriatric assessment (CGA). We investigated whether tumour site and metastatic status affected its accuracy.


METHODS



METHODS
Cross-sectional analysis of a prospective cohort study.


METHODS
Geriatric-oncology clinics of two teaching hospitals in the urban area of Paris.


METHODS
Patients aged 70 or over (n = 518) with breast ( n= 113), colorectal (n = 108), urinary-tract (n = 89), upper gastrointestinal/liver (n = 85), prostate (n = 69), or other cancers (n = 54).


METHODS
Reference standard for diagnosing vulnerability was the presence of at least one abnormal test among the Activities of Daily Living (ADLs), Instrumental ADL, Mini-Mental State Examination, Mini Nutritional Assessment, Cumulative Illness Rating Scale-Geriatrics, Timed Get-Up-and-Go, and Mini-Geriatric Depression Scale. Sensitivity, specificity and likelihood ratios of G-8 scores ≤ 14 were compared according to tumour site and patient characteristics.


RESULTS
Median age was 80; 48.2% had metastases. Prevalence of vulnerability and abnormal G-8 score was 84.2% (95% confidence interval [95% CI], 81-87.3) and 79.5% (95% CI, 76-83). The G-8 was 86.9% sensitive (95% CI, 83.4-89.9) and 59.8% specific (95% CI, 48.3-70.4). G-8 performance varied significantly (all p values < 0.001) across tumour sites (sensitivity, 65.2% in prostate cancer to 95.1% in upper gastrointestinal/liver cancer; and specificity, 23.1% in colorectal cancer to 95.7% in prostate cancer) and metastatic status (sensitivity and specificity, 93.8% and 53.3% in patients with metastases vs. 79.5% and 63.3% in those without, respectively). Differences remained significant after adjustment on age and performance status.


CONCLUSIONS
These G-8 accuracy variations across tumour sites should be considered when using G-8 to identify elderly patients with cancer who could benefit from CGA.
AP-HP, hôpital Henri-Mondor, Department of Internal Medicine and Geriatrics, Onco-Geriatric Clinic, F-94010 Créteil, France. Electronic address: evelyne.liuu@hmn.aphp.fr.
Evelyne
E
Liuu
Université Paris Est Créteil (UPEC), LIC EA 4393, F-94010 Créteil, France; AP-HP, hôpital Henri-Mondor, Department of Public Health, F-94010 Créteil, France.
Florence
F
Canouï-Poitrine
AP-HP, hôpital Henri-Mondor, Department of Medical Oncology, F-94010, France.
Christophe
C
Tournigand
AP-HP, hôpital Henri-Mondor, Department of Internal Medicine and Geriatrics, Onco-Geriatric Clinic, F-94010 Créteil, France; Université Paris Est Créteil (UPEC), LIC EA 4393, F-94010 Créteil, France.
Marie
M
Laurent
AP-HP, hôpital Henri-Mondor, Department of Internal Medicine and Geriatrics, Onco-Geriatric Clinic, F-94010 Créteil, France; Université Paris Est Créteil (UPEC), LIC EA 4393, F-94010 Créteil, France.
Philippe
P
Caillet
Université Paris Est Créteil (UPEC), LIC EA 4393, F-94010 Créteil, France; AP-HP, hôpital Henri-Mondor, Department of Public Health, F-94010 Créteil, France; AP-HP, hôpital Henri-Mondor, Clinical Research Unit (URC-Mondor), F-94010 Créteil, France.
Aurelie
A
Le Thuaut
AP-HP, hôpital Paul-Brousse, Department of Geriatrics, F-94804 Villejuif, France.
Helene
H
Vincent
AP-HP, hôpital Saint-Louis, Department of Medical Oncology, F-75010 Paris, France.
Stephane
S
Culine
Université Paris Est Créteil (UPEC), LIC EA 4393, F-94010 Créteil, France; AP-HP, hôpital Henri-Mondor, Department of Public Health, F-94010 Créteil, France.
Etienne
E
Audureau
Université Paris Est Créteil (UPEC), LIC EA 4393, F-94010 Créteil, France; AP-HP, hôpital Henri-Mondor, Department of Public Health, F-94010 Créteil, France; AP-HP, hôpital Henri-Mondor, Clinical Research Unit (URC-Mondor), F-94010 Créteil, France.
Sylvie
S
Bastuji-Garin
AP-HP, hôpital Henri-Mondor, Department of Internal Medicine and Geriatrics, Onco-Geriatric Clinic, F-94010 Créteil, France; Université Paris Est Créteil (UPEC), LIC EA 4393, F-94010 Créteil, France.
Elena
E
Paillaud
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis*; D011446:Prospective Studies; D012015:Reference Standards; D012680:Sensitivity and Specificity; D035862:Vulnerable Populations
Accuracy; Cancer; Elderly; Screening; Validation