title: Abridged geriatric assessment is a better predictor of overall survival than the Karnofsky Performance Scale and Physical Performance Test in elderly patients with cancer.
abstract: Comprehensive geriatric assessment (CGA) is a complex and interdisciplinary approach to evaluate the health status of elderly patients. The Karnofsky Performance Scale (KPS) and Physical Performance Test (PPT) are less time-consuming tools that measure functional status. This study was designed to assess and compare abridged geriatric assessment (GA), KPS and PPT as predictive tools of mortality in elderly patients with cancer.
  
  
  
  This prospective interventional study included all individuals aged >70years who were diagnosed with cancer during the study period. Subjects were interviewed directly using a procedure that included a clinical test and a questionnaire composed of the KPS, PPT and abridged GCA. Overall survival (OS) was the primary endpoint. The log rank test was used to compare survival curves, and Cox's regression model (forward procedure) was used for multivariate survival analysis.
  
  
  
  One hundred patients were included in this study. Abridged GA was the only tool found to predict mortality [median OS for unfit patients (at least two impairments) 467days vs 1030days for fit patients; p=0.04]. Patients defined as fit by mean PPT score (>20) had worse median OS (560 vs 721days); however, this difference was not significant (p=0.488 on log rank). Although median OS did not differ significantly between patients with low (≤80) and high (>80) KPS scores (467 and 795days, respectively; p=0.09), survival curves diverged after nearly 120days of follow-up. Visual and hearing impairments were the only components of abridged GA of prognostic value.
  
  
  
  Neither KPS nor PPT were shown to predict mortality in elderly patients with cancer whereas abridged GA was predictive. This study suggests a possible role for visual and hearing assessment as screening for patients requiring CGA.
authors.affiliation: Haematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. Electronic address: marwan.ghosn@usj.edu.lb.
authors.forename: Marwan
authors.initials: M
authors.lastname: Ghosn
authors.affiliation: Haematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Tony
authors.initials: T
authors.lastname: Ibrahim
authors.affiliation: Haematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Elie
authors.initials: E
authors.lastname: El Rassy
authors.affiliation: Staten Island University Hospital's Internal Medicine Residency Training Program, New York, NY, USA.
authors.forename: Najib
authors.initials: N
authors.lastname: Nassani
authors.affiliation: Staten Island University Hospital's Internal Medicine Residency Training Program, New York, NY, USA.
authors.forename: Sassine
authors.initials: S
authors.lastname: Ghanem
authors.affiliation: Haematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Tarek
authors.initials: T
authors.lastname: Assi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Comprehensive geriatric assessment; Geriatric oncology; Karnofsky Performance Status; Physical Performance Test; Survival