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Validation of the G8 screening tool in geriatric oncology: The ONCODAGE project.
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2011
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Cancer ManagementEpidemiology Of CancerPathologyScreening ToolOncologyCancer DetectionOncodage ProjectPublic HealthRadiation OncologyAbnormal Cga TestMolecular OncologyCancer ResearchRadiologyGeriatric OncologyGeriatricsCancer PrognosisAbnormal CgaCancer RiskCancer EpidemiologyCancer ScreeningMedicine
9001 Background: The risk of treatment-related toxicity increases with age and may even lead to toxic death. Comprehensive Geriatric Assessment (CGA) is an appropriate but time-consuming method. The development of a screening tool appears adequate. Based on a multicenter prospective cohort of 364 cancer patients > 70, we developed the G8 (8 items; range 0 [poor] to 17 [good prognosis]). Results suggested 14 as threshold, equivalent to 90% sensitivity, and 60% specificity. Methods: We have set up a national multicenter prospective cohort study to validate the G8, a quick and easy-to-use screening tool that can be performed routinely by oncologists. G8 and VES13 were evaluated to predict for at least one abnormal CGA test among CIRS-G, ADL, IADL, MMSE, MNA, GDS-15 and Timed Get up and Go. We estimated the necessary accrual to 1,650 patients (project funded by a French National Cancer Institute grant). Results: 1,668 patients have been included in 23 French cancer and geriatric centers (18 months). 1,590 patients were eligible and 1,425 evaluable: mean age 78.2 (70 to 98); 69.6% females; 75.9% PS 0-1; 53.7% breast, 14.2% colon, 10.5% lung, 8.6% prostate, 5.1% head and neck cancer and 7.9% lymphomas. Overall, abnormal CGA, G8 and VES13 were respectively 80.1%, 68.4% and 60.1%. Mean time to fill in G8 and VES13 were respectively 4.4’ and 4.3’. Reproducibility of the two questionnaires was good (kappa = 0.65, 95%CI [0.61; 0.69] vs 0.64, 95%CI [0.54; 0.73]). Sensitivity of G8 was superior to VES13 (76.6%, 95%CI [74.0%; 79.0%] vs 68.7%, 95%CI [65.9%; 71.4%]) although its specificity was inferior (64.4%, 95%CI [58.6%; 70.0%] vs 74.3%, 95%CI [68.8%; 79.3%]). When G8 and VES13 were used together (at least one abnormal test), sensitivity increased to 86.6% but specificity decreased to 53.2%. All results were confirmed in subgroup analyses (according to tumor type, extension, or previous treatment). Conclusions: These results validate G8 as a screening tool for patients older than 70 with cancer before therapy. Patients screened abnormal with G8 should benefit from at least increased medical attention or CGA followed by geriatric intervention when indicated.