title: PPT and VES-13 in elderly patients with cancer: evaluation in multidimensional geriatric assessment and prediction of survival.
abstract: OBJECTIVE
  The multidimensional geriatric assessment (MGA) detects impairments in the elderly and forms the basis for individualized treatment algorithms. Screening tools have been developed to detect patients in need of a full assessment. The aim of this pilot study was to evaluate the discriminative power and the prognostic impact of the screening scores for the Physical Performance Test (PPT) and the Vulnerable Elders Survey-13 (VES-13).
  
  
  METHODS
  In 77 patients with cancer aged ≥60years (median 74years) from the Department of Internal Medicine V, Innsbruck Medical University, VES-13 and PPT were performed and compared with data from MGA and clinical outcomes.
  
  
  RESULTS
  Overall, of the 77 patients 70% was deemed impaired, as defined by impairments in two or more scores of the MGA. The VES-13 showed 42% to be impaired, the PPT 79%. Using a cut-off of ≤19, the PPT exhibited better discriminative power than did the standard PPT (≤20). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of VES-13, PPT≤20 and PPT≤19 in the detection of impairments were 56% (88%, 82%), 91% (45%, 75%), 94% (80%, 89%), and 45% (60%, 63%) respectively. The area under the curve was 0.73 (0.67, 0.79), respectively. Both impaired VES-13 and PPT significantly correlated with an unfavorable overall survival in both uni- and multivariate analysis.
  
  
  CONCLUSIONS
  PPT (≤19) reveals favorable sensitivity, NPV and overall accuracy in elderly patients with cancer. Still, the NPV is too low to sufficiently discriminate between fit and frail patients. Both PPT and VES-13 are useful predictors for survival.
authors.affiliation: Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Augschoell
authors.affiliation: Department of Biological Psychiatry, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Kemmler
authors.affiliation: Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: Marije E
authors.initials: ME
authors.lastname: Hamaker
authors.affiliation: Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria. Electronic address: reinhard.stauder@i-med.ac.at.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Stauder
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D004185:Disability Evaluation; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016019:Survival Analysis
keywords: Cancer; Elderly; Geriatric assessment; PPT; Prediction of survival; Screening tools; VES-13