Screening older cancer patients for a Comprehensive Geriatric Assessment: A comparison of three instruments

Background: The Vulnerable Elders Survey (VES-13) has been validated for screening older cancer patients for a Comprehensive Geriatric Assessment (CGA). To identify a widely acceptable approach that encourages oncologists to screen older cancer patients for a CGA, we examined the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and Karnofsky Index of Performance Status (KPS) scales' ability to identify abnormalities on a CGA and compared the performance of the two instruments with the VES-13. Methods: We enrolled 117 participants, >= 65 years with stage I-IV cancer into this cross-sectional study. Our primary outcome variable was >= two abnormalities on the CGA, (Yes or No). We employed receiver operating characteristic curve analysis to compare the discriminatory abilities of the three instruments to identify >= two abnormalities on the CGA. Results: Of the 117 participants, 43% had >= two abnormalities on the CGA. The VES-13 was predictive of >= two abnormalities on the CGA, area under the curve (AUC). 0.85 [(95% CI: 0.78-0.92); sensitivity =88%, specificity =69%, at cut-off >= 3]. The ECOG-PS and KPS showed similar discriminatory powers, AUC=0.88 [(95% CI: 0.83-0.94); sensitivity =94%, specificity =55%, at cut-off >= 1]; and AUC=0.90 [(95% CI: 0.84-0.96); sensitivity =78%, specificity =91%, at cut-off <= 80%], respectively. Conclusion: The ECOG-PS and KPS were equivalent to the VES-13 in identifying older cancer patients with at least two abnormalities on the CGA. Given that oncologists are already conversant with the KPS and ECOG-PS, these two instruments offer medical oncologists a widely acceptable approach for screening older patients for a CGA. (C) 2010 Elsevier Ltd. All rights reserved.