title: Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study.
abstract: BACKGROUND
  Geriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13).
  
  
  METHODS
  The diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate.
  
  
  RESULTS
  Patient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P =  0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, P<0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival.
  
  
  CONCLUSIONS
  With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy.
authors.affiliation: Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; University of Bordeaux, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Soubeyran
authors.affiliation: Clinical and Epidemiological Research unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; INSERM U897 (Institut national de la santé et de la recherche médicale), CIC1401 (Centre d'investigation clinique), Institut Bergonié, Bordeaux, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Bellera
authors.affiliation: Oncogeriatric Coordination unit, Centre Jean Perrin, Clermont-Ferrand, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Goyard
authors.affiliation: Oncology and Hematology unit, Centre Hospitalier Universitaire de Strasbourg - Hôpital de Hautepierre, Strasbourg, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Heitz
authors.affiliation: Geriatric unit, Institut Jean Godinot, Reims, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Curé
authors.affiliation: Cancer Support unit, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Rousselot
authors.affiliation: Geriatric Evaluation and Management unit, Antoine Charial Hospital, Francheville, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Albrand
authors.affiliation: Breast Cancer unit, Centre Oscar Lambret, Lille, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Servent
authors.affiliation: Internal Medicine unit, Hôpital européen Georges-Pompidou, Paris, France.
authors.forename: Olivier Saint
authors.initials: OS
authors.lastname: Jean
authors.affiliation: Oncogeriatric Coordination unit, Centre Jean Perrin, Clermont-Ferrand, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: van Praagh
authors.affiliation: Oncology and Hematology unit, Centre Hospitalier Universitaire de Strasbourg - Hôpital de Hautepierre, Strasbourg, France.
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: Kurtz
authors.affiliation: Geriatric unit, Institut Jean Godinot, Reims, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Périn
authors.affiliation: Surgical Oncology unit, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Verhaeghe
authors.affiliation: Medical Oncology unit, Centre Léon Bérard, Lyon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Terret
authors.affiliation: Senology unit, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Desauw
authors.affiliation: Oncology and Haematology unit, Centre Hospitalier Départemental, La Roche sur Yon, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Girre
authors.affiliation: Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; Department of Clinical Gerontology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Mertens
authors.affiliation: University of Bordeaux, Bordeaux, France; Clinical and Epidemiological Research unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; INSERM U897 (Institut national de la santé et de la recherche médicale), CIC1401 (Centre d'investigation clinique), Institut Bergonié, Bordeaux, France.
authors.forename: Simone
authors.initials: S
authors.lastname: Mathoulin-Pélissier
authors.affiliation: University of Bordeaux, Bordeaux, France; Department of Clinical Gerontology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Rainfray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D009726:Nurses; D010820:Physicians; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome