title: Estimating the risk of chemotherapy toxicity in older patients with cancer: The role of the Vulnerable Elders Survey-13 (VES-13).
abstract: OBJECTIVE
  Some parameters of the Comprehensive Geriatric Assessment (CGA) are predictive of chemotherapy toxicity. The Vulnerable Elders Survey-13 (VES-13) is a short instrument that has been tested as a means of identifying patients who need a full CGA, but its ability to predict chemotherapy toxicity is still unclear. We performed a pooled analysis of four published clinical trials studying VES-13 as a means of diagnosing vulnerability, in order to evaluate its accuracy in predicting the risk of grade 3/4 toxicity in older patients undergoing chemotherapy.
  
  
  METHODS
  The study involved patients aged ≥ 66 years with a diagnosis of solid or hematological cancer, all of whom were administered VES-13. The number of medications taken by each patient, their comorbidities, their Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score and index, the type of chemotherapy and treatment line, and their Mini Mental State Evaluation (MMSE), and Mini Nutritional Assessment (MNA) scores were recorded. Information was available concerning the grades 3-4 hematological and non-hematological toxicities experienced by each patient.
  
  
  RESULTS
  The study involved 648 patients aged ≥ 66 years (mean age 76.2±4.5, range 66-90) of whom 336 (51.9%) were female. VES-13 identified 287 patients (44.3%) as vulnerable. Grades 3-4 hematological and non-hematological toxicities were more prevalent in the vulnerable subjects (35.2% vs 20.8%, p<0.0001, and 18.5% vs 10.8%, p=0.0055), who were also at higher risk of both (adjusted ORs 2.15, 95% CI 1.46-3.17, p<0.001); and 1.66 (95% CI 1.02-2.72, p=0.043).
  
  
  CONCLUSIONS
  VES-13 could be considered to be a good candidate for future prospective studies to assess older patients with cancer at risk of toxicity.
authors.affiliation: Department of Oncology, San Paolo Hospital, Milan, Italy. Electronic address: andrea_luciani@email.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Luciani
authors.affiliation: Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Prato, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Biganzoli
authors.affiliation: Aging and Medicine Centre, Università Cattolica Sacro Cuore, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colloca
authors.affiliation: Department of Oncology, Istituto Oncologico, Veneto, Padua, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Falci
authors.affiliation: Department of Oncology San Giacomo Hospital, Novi Ligure, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Castagneto
authors.affiliation: Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Floriani
authors.affiliation: Department of Oncology, San Paolo Hospital, Milan, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Battisti
authors.affiliation: Department of Oncology, San Paolo Hospital, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Dottorini
authors.affiliation: Department of Oncology, San Paolo Hospital, Milan, Italy.
authors.forename: Daris
authors.initials: D
authors.lastname: Ferrari
authors.affiliation: Department of Oncology, Istituto Oncologico, Veneto, Padua, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fiduccia
authors.affiliation: Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Prato, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Zafarana
authors.affiliation: Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Prato, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Del Monte
authors.affiliation: Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Galli
authors.affiliation: IRCCS Geriatric Oncology Unit, Fondazione Don Gnocchi, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Monfardini
authors.affiliation: Department of Oncology, San Paolo Hospital, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Foa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006306:Health Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D015203:Reproducibility of Results
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Older; Toxicity; VES-13