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Annals of Oncology 24: 494–500, 2013 doi:10.1093/annonc/mds331 Published online 7 October 2012
Evaluation of the cardiovascular health study (CHS) instrument and the Vulnerable Elders Survey-13 (VES-13) in elderly cancer patients. Are we still missing the right screening tool? L. Biganzoli1*, L. Boni2, D. Becheri1, E. Zafarana1, C. Biagioni1, S. Cappadona1, E. Bianchini2, C. Oakman1, S. U. Magnolfi3, A. Di Leo1 & G. Mottino3 1
Sandro Pitigliani Medical Oncology Unit, Department of Oncology, Hospital of Prato, Istituto Toscano Tumori, Prato; 2Clinical Trials Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Florence; 3Geriatric Medicine Unit, Hospital of Prato, Prato, Italy
Received 29 May 2012; revised 5 July 2012; accepted 11 July 2012
Background: A geriatric screening tool would be valuable to identify elderly cancer patients who might benefit from a comprehensive geriatric assessment (CGA). This study evaluated the accuracy of the cardiovascular health study (CHS) instrument in predicting abnormality in CGA. The vulnerable elders’ survey-13 (VES-13) was also evaluated. Patients and methods: Patients aged ≥70 years with solid tumors underwent a CGA after being screened with the CHS and VES-13. Analyses were conducted for the overall population and according to the disease status (early or advanced) and type of early cancer (breast or gastrointestinal, GI). Results: Of 259 patients, 75% were impaired according to the CHS and 47% according to the VES-13. CGA impairment was reported in 171 patients (66%). In the overall population, overall accuracy, sensitivity and specificity of CHS in identifying CGA impairments were 74%, 87% and 49%, respectively. The corresponding figures for the VES-13 were 68%, 62% and 81%. Sensitivity and specificity of CHS in predicting CGA impairments in subgroups were early 81% and 55%, advanced 98% and 29%; early breast 78% and 69%, early GI 87.5% and 19%. Conclusions: The CHS compared favourably with VES-13 for sensitivity. However, the great variability in specificity observed with the CHS within subgroups limits its applicability in the global population. Key words: cancer, elderly, geriatric assessment, screening tool
*Correspondence to: Dr L. Biganzoli, Sandro Pitigliani Medical Oncology Unit, Department of Oncology, Hospital of Prato, Istituto Toscano Tumori, Piazza Ospedale 2, 59100 Prato, Italy. Tel: +39-0574-434766; Fax: +39-0574 -29798; E-mail:
[email protected]
© The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email:
[email protected].
original articles
Annals of Oncology
introduction The elderly population is markedly diverse, in which the chronological age alone is a poor representative marker. General health and functional status for an older individual may be captured in a comprehensive geriatric assessment (CGA) [1–9]. A geriatric evaluation might contribute to improved management decisions in older cancer patients [10–12]. The time requirements for CGA are substantial, and as such, an abbreviated screening tool would be valuable [13–17]. There is no consensus on which of the available screening tests should be used [18]. The cardiovascular health study (CHS) instrument is a screening tool developed to identify frail patients on the basis of five simple tests [19]. Frail patients have three or more of the following: unintentional weight loss (≥10 lbs in the past year), self-reported exhaustion, weakness (grip strength), slow walking speed and/or low physical activity. Patients having one to two abnormalities are defined as pre-frail, while fit/robust patients without abnormalities are defined as fit. Frail, pre-frail and fit patients have different 5-year mortality rates and different risks of developing functional dependence at 3 and 7 years. The CHS may be helpful to screen whether elderly cancer patients require a CGA [20–21]. The Vulnerable Elders Survey-13 (VES-13), a function-based scoring system, identifies a group of patients with a score ≥3, defined as vulnerable, which has 4.2 times the risk of death or functional decline over a 2-year period compared with patients with scores
