scholarly journals Predictive ability of the G8 screening test to determine probable sarcopenia and abnormal comprehensive geriatric assessment in older patients with solid malignancies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cagatay Cavusoglu ◽  
Gozde Tahtaci ◽  
Rana Tuna Dogrul ◽  
Ibrahim Ileri ◽  
Funda Yildirim ◽  
...  

Abstract Background Pre-treatment evaluation for sarcopenia is recommended in cancer patients. New screening tests that are less time-consuming and can identify patients who will potentially benefit from geriatric assessment are being developed; the G8 geriatric screening test is one such example. We aimed to investigate whether the G8 screening test can detect probable sarcopenia and is valid and reliable compared to a comprehensive geriatric assessment (CGA) in Turkish older adults with solid cancers. Methods We included solid cancer patients referred to a single center. Probable sarcopenia and abnormal CGA were defined as low handgrip strength. Cut-offs for handgrip strength in the Turkish population have been previously determined to be 32 kg for males and 22 kg for females and impairment in at least one of the CGA tests, respectively. The CGA tests comprised KATZ Basic Activities of Daily Living Scale Lawton–Brody Instrumental Activities of Daily Living Scale, Mini-Mental-State Examination Scale, Geriatric Depression Scale-15, and Mini-Nutritional Assessment Short Form. Receiver operating characteristic curve analyses evaluated the test’s predictive ability. Intra-rater and inter-rater reliabilities were assessed. Results The median age of the 76 patients included was 72 (65–91) years. There was a moderate correlation between handgrip strength and the G8 test total score. The sensitivity and specificity of the G8 test to detect probable sarcopenia alone (cut off score = 12.5) were 50 and 92%, respectively (AUC: 0.747; p < 0.001); to determine abnormal CGA plus probable sarcopenia (cut off score = 13) were 93.33 and 86.89%, respectively (AUC: 0.939; p < 0.001); and to detect abnormal CGA alone (cut off score = 14) were 79.63 and 95.45%, respectively (AUC: 0.893; p < 0.001). The G8 test results agreed with those of CGA (κ = 0.638; p < 0.001). Both inter- and intra-rater assessments of G8 scores revealed a strong agreement (Interclass correlation coefficient = 0.979, p < 0.001 and ρ = 0.994, p < 0.001, respectively). Conclusions The Turkish version of the G8 test is a good screening tool to detect probable sarcopenia alone and in conjunction with abnormal CGA in older patients with solid malignancies. The G8 screening tool may thus be useful in detecting probable sarcopenia in Turkish older adults with solid cancers.

2021 ◽  
Author(s):  
Cagatay Cavusoglu ◽  
Gozde Tahtaci ◽  
Rana Tuna Dogrul ◽  
Ibrahim Ileri ◽  
Funda Yildirim ◽  
...  

Abstract Background: Pre-treatment evaluation for sarcopenia is recommended in cancer patients. We aimed to investigate whether the G8 screening test can detect probable sarcopenia and is valid and reliable compared to comprehensive geriatric assessment (CGA) in Turkish older adults with solid cancers.Methods: We included solid cancer patients referred to a single center. Probable sarcopenia and abnormal CGA were defined as low handgrip strength and impairment in at least one of the CGA tests, respectively. Receiver operating characteristic curve analyses evaluated the test’s predictive ability. Intra-rater and inter-rater reliabilities were assessed.Results: The median age of the 76 patients included was 72 (65–91) years. There was a moderate correlation between handgrip strength and the G8 test total score. The sensitivity and specificity of the G8 test to detect probable sarcopenia alone were 50% and 92%, respectively (area under the curve [AUC]: 0.747; p<0.001); to determine abnormal CGA plus probable sarcopenia were 93.33% and 86.89%, respectively (AUC: 0.939; p<0.001), and to detect abnormal CGA alone were 79.63% and 95.45%, respectively (AUC: 0.893; p<0.001). The G8 test results agreed with those of CGA (κ=0.638; p<0.001). Both inter- and intra-rater assessments of G8 scores revealed a strong agreement (Interclass correlation coefficient (ICC)=0.979, p<0.001 and ρ=0.994, p<0.001, respectively). Conclusions: The Turkish version of the G8 test is a good screening tool to detect probable sarcopenia alone and in conjunction with abnormal CGA in older patients with solid malignancies. The G8 screening tool may be useful in detecting probable sarcopenia in Turkish older adults with solid cancers.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19651-19651
Author(s):  
M. Molina-Garrido ◽  
C. Guillén-Ponce ◽  
A. Carrato

19651 Background: Age is the major risk factor for the majority of patients with cancer. More than 50% of cancers occurs after the age of 60. Older patients are not simply old, but are geriatric patients because of interacting psychosocial and physical problems. As a consequence, the health status of old persons cannot be evaluated by merely describing the single disease or the group of age. We tested the performance of a new Comprehensive Geriatric Assessment (CGA) and its relationship with groups of age in cancer patients. Methods: Between June 2006 and December 2006, a total of 64 oncologic patients older than 75 years were approached to enrol in our study to analyze their functional, physical, mental, pharmacotherapeutic and socio-economic status and to correlate them to some groups of age: youngest-old (75 to 80 years-old), old-old (80 and 85 years-old) and oldest-old (older than 85 years). They were analysed Activities of Daily Living (ADL) measured by Barthel Scale, Instrumental Activities of Daily Living (IADL) measured by Lawton-Brody Scale, Grade of Fragility measured by Barber Scale, cognitive evaluation measured by Pfeiffer Test, and medication intake. A Chi Squared test was used for statistical analysis; p-value <0,05 was considered significative. Results: Sixty-four oncologic patients age > or = 75 years were recruited. Median age was 80.24 years (range 73.88 to 86.94). 51.6% female. Breast cancer was the most frequent diagnosis (30.2%), followed by lung cancer (19%). 29 patients (45.3%) were aged between 75 and 80 years old; 27 patients (43.5%) were between 80 and 85 years- old. There were statistic significative association between groups of age and Pfeiffer Test (p=0.037), Barber Scale (p=0.031) and medication intake (p=0.021). However, there was not a significative relationship between groups of age and Barthel Scale (p=0.052), Lawton-Brody Scale (p=0.2425), Cruz-Roja Scale (p=0,1485) or number of geriatric syndromes (p=0.129). Conclusions: This abstract reviews the findings regarding the correlation between a comprehensive geriatric assessment (CGA) and groups of age in older patients with cancer. Age per se must not be the only criterion for medical decision as it is not correlated to the health status of older cancer patients. No significant financial relationships to disclose.


2014 ◽  
pp. 1-4
Author(s):  
T. LOPEZ-TEROS ◽  
L.M. GUTIERREZ-ROBLEDO ◽  
M.U. PEREZ-ZEPEDA

Physical performance tests are associated with different adverse outcomes in older people. Theobjective of this study was to test the association between handgrip strength and gait speed with incidentdisability in community-dwelling, well-functioning, Mexican older adults (age ≥70 years). Incident disability wasdefined as the onset of any difficulty in basic or instrumental activities of daily living. Of a total of 133participants, 52.6% (n=70) experienced incident disability during one year of follow-up. Significant associationsof handgrip strength (odds ratio [OR] 0.96, 95% confidence interval [95%CI] 0.93-0.99) and gait speed (OR0.27, 95%CI 0.07-0.99) with incident disability were reported. The inclusion of covariates in the models reducedthe statistical significance of the associations without substantially modifying the magnitude of them. Handgripstrength and gait speed are independently associated with incident disability in Mexican older adults.


2018 ◽  
Vol 74 (10) ◽  
pp. 1650-1656 ◽  
Author(s):  
Esmee M Reijnierse ◽  
Sjors Verlaan ◽  
Vivien K Pham ◽  
Wen Kwang Lim ◽  
Carel G M Meskers ◽  
...  

Abstract Background Approximately 10% of older adults are annually admitted to a hospital. Hospitalization is associated with a higher risk of falls and mortality after discharge. This study aimed to identify predictors at admission for falls and mortality 3 months post-discharge in hospitalized older patients. Methods The Evaluation of Muscle parameters in a Prospective cohort of Older patients at clinical Wards Exploring Relations with bed rest and malnutrition (EMPOWER) study is an observational, prospective longitudinal inception cohort of 378 patients aged 70 years and older who were subsequently admitted to a tertiary hospital (the Netherlands). Potential predictors for falls and mortality 3 months post-discharge were tested using univariate and multivariate logistic regression analyses and included the following domains: demographic (age, sex, living independently), lifestyle (alcohol, smoking), nutrition (SNAQ score), muscle mass (absolute, relative), physical function (handgrip strength, Katz ADL score), cognition (six-item cognitive impairment test score), and disease (medications, diseases). Results The mean age was 79.6 years (standard deviation 6.23) and 50% were male. Within 3 months post-discharge, 19% reported a fall and 13% deceased. Univariate predictors for falls were higher age, lower absolute muscle mass and higher six-item cognitive impairment test score. Lower absolute muscle mass independently predicted falls post-discharge (multivariate). Univariate predictors for mortality were higher age, male sex, no current alcohol use, higher SNAQ score, lower absolute and higher relative muscle mass, higher Katz ADL score and higher number of diseases. Male sex, higher SNAQ score, and lower absolute muscle mass independently predicted mortality post-discharge (multivariate). Conclusions In hospitalized older adults, muscle mass should be measured to predict future outcome. Future intervention studies should investigate if increasing muscle mass prevent short-term falls and mortality.


2002 ◽  
Vol 20 (2) ◽  
pp. 494-502 ◽  
Author(s):  
Lazzaro Repetto ◽  
Lucia Fratino ◽  
Riccardo A. Audisio ◽  
Antonella Venturino ◽  
Walter Gianni ◽  
...  

PURPOSE: To appraise the performance of Comprehensive Geriatric Assessment (CGA) in elderly cancer patients (≥ 65 years) and to evaluate whether it could add further information with respect to the Eastern Cooperative Oncology Group performance status (PS). PATIENTS AND METHODS: We studied 363 elderly cancer patients (195 males, 168 females; median age, 72 years) with solid (n = 271) or hematologic (n = 92) tumors. In addition to PS, their physical function was assessed by means of the activity of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comorbidities were categorized according to Satariano’s index. The association between PS, comorbidity, and the items of the CGA was assessed by means of logistic regression analysis. RESULTS: These 363 elderly cancer patients had a good functional and mental status: 74% had a good PS (ie, lower than 2), 86% were ADL-independent, and 52% were IADL-independent. Forty-one percent of patients had one or more comorbid conditions. Of the patients with a good PS, 13.0% had two or more comorbidities; 9.3% and 37.7% had ADL or IADL limitations, respectively. By multivariate analysis, elderly cancer patients who were ADL-dependent or IADL-dependent had a nearly two-fold higher probability of having an elevated Satariano’s index than independent patients. A strong association emerged between PS and CGA, with a nearly five-fold increased probability of having a poor PS (ie, ≥ 2) recorded in patients dependent for ADL or IADL. CONCLUSION: The CGA adds substantial information on the functional assessment of elderly cancer patients, including patients with a good PS. The role of PS as unique marker of functional status needs to be reappraised among elderly cancer patients.


2007 ◽  
Vol 25 (14) ◽  
pp. 1824-1831 ◽  
Author(s):  
Martine Extermann ◽  
Arti Hurria

Purpose During the last decade, oncologists and geriatricians have begun to work together to integrate the principles of geriatrics into oncology care. The increasing use of a comprehensive geriatric assessment (CGA) is one example of this effort. A CGA includes an evaluation of an older individual's functional status, comorbid medical conditions, cognition, nutritional status, psychological state, and social support; and a review of the patient's medications. This article discusses recent advances on the use of a CGA in older patients with cancer. Methods In this article, we provide an update on the studies that address the domains of a geriatric assessment applied to the oncology patient, review the results of the first studies evaluating the use of a CGA in developing interventions to improve the care of older adults with cancer, and discuss future research directions. Results The evidence from recent studies demonstrates that a CGA can predict morbidity and mortality in older patients with cancer. Accumulating data show the benefits of incorporating a CGA in the evaluation of older patients with cancer. Prospective trials evaluating the utility of a CGA to guide interventions to improve the quality of cancer care in older adults are justified. Conclusion Growing evidence demonstrates that the variables examined in a CGA can predict morbidity and mortality in older patients with cancer, and uncover problems relevant to cancer care that would otherwise go unrecognized.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5209-5209 ◽  
Author(s):  
Reinhard Stauder ◽  
Martina Mitrovic ◽  
Guenther A. Gastl ◽  
Marije E Hamaker

Abstract Introduction Haematological neoplasias in elderly represent a major challenge, as median age at diagnosis is 70+ years in frequent and clinically relevant diseases such as acute myeloid leukaemia (AML), multiple myeloma or chronic lymphocytic leukaemia (CLL). Thus, algorithms for individualised treatment of elderly are urgently needed. The G8 screening tool was developed to separate fit older cancer patients able to receive standard treatment from those that should undergo a geriatric assessment to guide tailoring of therapy. In this study the discriminative power and prognostic relevance of G8 in a well-defined cohort of elderly patients with a haematological malignancy was analysed. Methods Between September 2009 and May 2013, in 108 consecutive patients aged ≥67 years diagnosed with blood cancer at the Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University a multi-dimensional geriatric assessment (MGA) was performed. The most frequent entities included were AML (29%), myelodysplastic syndromes (23%) and aggressive or indolent Non-Hodgkin lymphomas (29 and 12%, respectively).  MGA assessed the dimensions (instrumental) activities of daily living (ADL/iADL), cognition, mood, nutritional status, mobility, polypharmacy and social support. The G8-scoring was administered in parallel, using a cut-off ≤14.  The discriminative power of the G8 for detecting the presence of an impaired geriatric assessment (defined as impairments in ≥2 geriatric domains) was calculated from a 2x2 table. For comparisons between patients with a normal G8 score and those with an impaired G8, the chi-square test and risk analysis were used for nominal and ordinal variables, as well as for continuous variables with a non-normal distribution; for continuous variables with a normal distribution, the Student t-test was used. The impact of variables on mortality was evaluated by uni- and multivariate Cox-regression analyses. Results Prevalance of geriatric conditions in haematological malignancies was high. Applying a cut-off ≥2 impaired domains, 70% of patients were scored as being impaired. Domains most often involved were iADL (iADL ≤6: 45%), polypharmacy (≥5 medications: 65%) and malnutrition (BMI ≤18kg/m2 and/or weight loss ≥1kg in last 3 months: 45%). An impaired G8 was observed in 61% of cases and revealed a significant correlation with MGA (cc=-0.624; p <0.001). However, the G8 lacked discriminative power for impairments on MGA, with a sensitivity of 69%, a specificity of 79%, a negative predictive value of 50% and a positive predictive value of 89%. One-year mortality was correlated with diagnosis of AML (hazard ratio (HR) 1.24, 95%-confidence interval (CI) 1.06-1.44; p=0.01)), impaired mobility (timed up and go test ≥12 seconds) (3.20 (1.26-8.14); p=0.02) and risk of malnutrition (1.31 (1.07-1.37); p=0.01) in uni- and in multivariate analyses. Remarkably, G8 was an independent predictor of mortality within the first year after inclusion, displaying a HR of 3.93 (95%-CI 1.67-9.22; p=0.002). Conclusion This is the first report on the clinical and prognostic relevance of G8 in a well-defined cohort of elderly patients with a haematological malignancy. Clinical relevant restrictions were identified in a substantial proportion of patients. Due to the high prevalence of geriatric impairments, the G8 lacked discriminative power. However, G8 appears to be a powerful prognosticator and might thus represent a useful tool in treatment decisions. This novel finding certainly deserves further exploration. Disclosures: No relevant conflicts of interest to declare.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21703-e21703 ◽  
Author(s):  
Nitya Nathwani ◽  
Supriya Gupta Mohile ◽  
Brea Lipe ◽  
Karen Carig ◽  
Laura DiGiovanni ◽  
...  

e21703 Background: Multiple myeloma (MM) is a disease of older adults (OAs) with > 60% of diagnoses and nearly 75% of deaths occurring in patients > 65 years old (YO). Geriatric Assessment (GA) is associated with toxicity and survival in OAs with MM, but not routinely used in practice. This project pilot tests a tablet-based modified Geriatric Assessment (mGA) that presents compiled GA results, including (the Palumbo) frailty score, to clinicians at a treatment decision-making visit in a single screen dashboard. Methods: In this multisite ongoing study, 210 patients with MM ≥65 YO facing a decision point for care will complete a mGA that includes the Charlson Comorbidity Index (CCI), Katz Activity of Daily Living (ADL) Score, and Lawton Instrumental Activity of Daily Living (IADL) Score prior to meeting with a physician. mGA results, including composite frailty score, are provided to physicians at the start of a visit. Results: Thirty-six patients have been enrolled to date; enrollment continues. Participants are 69% (n = 25) white, 64% (n = 23) male, and mean age of 72 YO (range 65-87). Most (74%, n = 20) currently receive ≥1 therapy and have few co-morbidities (CCI median 1, SD 1.95, range 0-8); 57% require assistance with IADLs and 37% require assistance with ADLs. Based on Palumbo score, 36% of participants were frail (n = 13), 33% intermediate (n = 12), and 31% fit (n = 11). Providers report mGA results influenced treatment decision (54%, n = 28) and frailty score was the most frequently cited result to impact treatment decision-making (61%, n = 39). The most common way the mCGA influenced decision-making was to reduce dose/dose intensity (25%, N = 8). Clinicians on average spent 5 minutesreviewing the mGA results. Patients reported an average of 7 minutes to complete the survey, most independently (83%, n = 30), and were satisfied with the electronic program overall (80%, n = 29), including how easy it was to use (88%, n = 32). Conclusions: Preliminary data support feasibility, usability, and acceptability of the tablet-based mGA and that frailty score influences provider decision-making ≥50% of the time. Future analyses will explore the relationship of the mGA with toxicity, dose modification and/or treatment discontinuation in OAs with MM.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18140-e18140 ◽  
Author(s):  
Beatrice Jara-Almonte Edwards ◽  
Xiaotao Zhang ◽  
Ming Sun ◽  
Juhee Song ◽  
Colin P.N. Dinney ◽  
...  

e18140 Background: More than 60% of cancer patients are older adults, and by 2020 the proportion of older adults with cancer will rise to 70%. Objective: To assess risk factors for overall survival (OS) in older cancer patients seen in a comprehensive cancer center. Methods: This is a single center, retrospective cohort study of older cancer patients (65 years of age and older). Patients receiving active cancer care underwent comprehensive geriatric assessment (including cognitive, mood, functional, nutritional, physical, and comorbidity assessment using validated scales). Hematologic, and solid tumors (urologic, breast, gastrointestinal cancers) were evaluated. Targeted interventions were implemented. Analysis: Univariate and multivariable Cox proportional hazards regression analysis were performed to identify factors associated with OS (SAS 9.4). Results: Among 304 eligible patients, the median follow-up was 12.7 months, 98 (32%) died, the median OS was 25.4 months. Median age is 78 years. Univariate analysis revealed known risk factors for mortality (advanced age [p = 0.004], and metastatic disease [p = 0.002]), functional impairment (ADL scores 0-4, p = 0.02), and major depression (p = 0.005). Comorbidity (p = 0.07) and functional impairment showed a marginal significance on OS. Factors with a univariate p-value less than 0.1 were considered in multivariable regression models. A final multivariable model included age group, cancer stage, functional impairment, and major depression. Risk factors for OS include major depression (HR 1.88 (95% CI, 1.12, 3.15), p-value = 0.02), functional impairment (HR 2.47 (95% C.I. 1.28, 4.74), p = 0.007), and metastatic disease (HR 2.2 (95% C.I. 1.30, 3.97), p = 0.004). Conclusions: Major depression and functional impairment were identified as risk factors for OS in older cancer patients. Prospective studies are recommended.


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