How to identify older patients with cancer who should benefit from comprehensive geriatric assessment?

Introduction: Although many studies describe benefits from the comprehensive assessment of older patients, the lack of geriatricians combined with the increased number of elderly patients revealed the need for screening tools in order to detect cancer patients presenting with geriatric conditions. Objectives: (i) To assess the validity of screening tools to detect patients presenting with geriatric conditions. (ii) To analyze the relative contribution of those tools to detect some characteristics of the geriatric profile and the stage of the tumors. Materials and Methods: Two hundred eleven consecutive elderly patients were screened for the presence of geriatric conditions using the Identification of Senior At Risk score (TSAR) and the G8 score. Comprehensive geriatric assessment for functional, cognitive, mood, and nutritional status, self-perceived fatigue and comorbidities was performed. Oncological assessment included the Kamofsky performance status (KPS) and tumor staging. Results: Both scores detected an average of 80% of frail patients. The PPV and NPV of the scores to detect at least one geriatric condition were respectively 47% and 22% for an ISAR score >= 2 and 76% and 10% for a G8 <15. Area under the ROC curves between ISAR and G8 was not statistically different. In logistic models an TSAR score >= 2 was associated with comorbidity and falls whereas a G8 score <15 was associated with low KPS (<80) and the presence of generalized cancer. Conclusions: High prevalence of geriatric syndromes and comorbidities is associated with positive ISAR and G8 scores but not with the tumor stage. (C) 2012 Elsevier Ltd. All rights reserved.