Advertisement

The benefits of G8 and VES-13 geriatric screening tools for older patients with advanced lung cancer

      Cancer is a disease of ageing. There is scarce evidence to guide proper cancer treatment decisions for this population because older patients, especially those with age-related comorbidities, are under-represented in clinical trials [
      • Hurria A.
      • Dale W.
      • Mooney M.
      • Rowland J.H.
      • Ballman K.V.
      • Cohen H.J.
      • et al.
      Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations.
      ]. During the past decades, there have been major breakthroughs in non-small cell lung cancer treatment. Up to half of the Asian patients with adenocarcinoma harbor epidermal growth factor receptor (EGFR) mutations – the predictive biomarker of EGFR tyrosine kinase inhibitors (EGFR TKIs) [
      • Wiriyaukaradecha K.
      • Bunyoo C.
      • Udomchaiprasertkul W.
      • Sricharunrat T.
      • Petchjorn S.
      • Lamlertthon W.
      • et al.
      Frequency of EGFR mutations among Thai non-small cell lung cancer [NSCLC] patients.
      ]. Accessibility to EGFR TKIs led to a significant improvement in survival among Asian patients. Some of the older adult patients with lung cancer are vulnerable to treatment-related toxicities [
      • Pallis A.G.
      • Karampeazis A.
      • Vamvakas L.
      • Vardakis N.
      • Kotsakis A.
      • Bozionelou V.
      • et al.
      Efficacy and treatment tolerance in older patients with NSCLC: a meta-analysis of five phase III randomized trials conducted by the Hellenic oncology research group.
      ]. Studies have shown that conventional performance status assessment, such as the Karnofsky Performance Status (KPS) or Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) scores, do not precisely predict which older adults are at the highest risk of adverse outcomes from chemotherapy [
      • Hurria A.
      • Mohile S.
      • Gajra A.
      • Klepin H.
      • Muss H.
      • Chapman A.
      • et al.
      Validation of a prediction tool for chemotherapy toxicity in older adults with cancer.
      ]. In patients ≥65 years receiving chemotherapy, the Comprehensive Geriatric Assessment (CGA) is a validated tool to predict chemotherapy toxicity that is not accurately predicted by traditional assessments pursued by oncologists. Moreover, GA tools measuring the domains of function, nutrition, and depression have been demonstrated to independently predict mortality [
      • Kanesvaran R.
      • Li H.
      • Koo K.N.
      • Poon D.
      Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer.
      ]. However, the CGA is time-consuming. In contrast, the Geriatric 8 (G8) and Vulnerable Elders Survey-13 (VES-13) questionnaires are quick and easy-to-use screening tools that take less than five minutes to administer. Several recent studies showed that the G8 [
      • van Walree I.C.
      • Scheepers E.
      • van Huis-Tanja L.
      • Emmelot-Vonk M.H.
      • Bellera C.
      • Soubeyran P.
      • et al.
      A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer.
      ] and VES-13 [
      • Biganzoli L.
      • Mislang A.R.
      • Di Donato S.
      • Becheri D.
      • Biagioni C.
      • Vitale S.
      • et al.
      Screening for frailty in older patients with early-stage solid tumors: a prospective longitudinal evaluation of three different geriatric tools.
      ] questionnaires had a high sensitivity for predicting abnormalities in the full CGA and impaired scores were significantly related to poor survival outcome in various kinds of cancer. The G8 has a relatively high sensitivity for frailty; however, it has poorer specificity [
      • van Walree I.C.
      • Scheepers E.
      • van Huis-Tanja L.
      • Emmelot-Vonk M.H.
      • Bellera C.
      • Soubeyran P.
      • et al.
      A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer.
      ]. This study was intended to determine the prevalence of frail older adults with lung cancer and to demonstrate whether G8 and VES-13 scores could predict the survival of older adult patients with lung cancer receiving the systemic therapy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Geriatric Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hurria A.
        • Dale W.
        • Mooney M.
        • Rowland J.H.
        • Ballman K.V.
        • Cohen H.J.
        • et al.
        Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations.
        J Clin Oncol. 2014; 32: 2587-2594
        • Wiriyaukaradecha K.
        • Bunyoo C.
        • Udomchaiprasertkul W.
        • Sricharunrat T.
        • Petchjorn S.
        • Lamlertthon W.
        • et al.
        Frequency of EGFR mutations among Thai non-small cell lung cancer [NSCLC] patients.
        J Med Assoc Thai. 2018; 101: 131
        • Pallis A.G.
        • Karampeazis A.
        • Vamvakas L.
        • Vardakis N.
        • Kotsakis A.
        • Bozionelou V.
        • et al.
        Efficacy and treatment tolerance in older patients with NSCLC: a meta-analysis of five phase III randomized trials conducted by the Hellenic oncology research group.
        Ann Oncol. 2011; 22: 2448-2455
        • Hurria A.
        • Mohile S.
        • Gajra A.
        • Klepin H.
        • Muss H.
        • Chapman A.
        • et al.
        Validation of a prediction tool for chemotherapy toxicity in older adults with cancer.
        J Clin Oncol. 2016; 34: 2366-2371
        • Kanesvaran R.
        • Li H.
        • Koo K.N.
        • Poon D.
        Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer.
        J Clin Oncol. 2011; 29: 3620-3627
        • van Walree I.C.
        • Scheepers E.
        • van Huis-Tanja L.
        • Emmelot-Vonk M.H.
        • Bellera C.
        • Soubeyran P.
        • et al.
        A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer.
        J Geriatr Oncol. 2019; 10: 847-858
        • Biganzoli L.
        • Mislang A.R.
        • Di Donato S.
        • Becheri D.
        • Biagioni C.
        • Vitale S.
        • et al.
        Screening for frailty in older patients with early-stage solid tumors: a prospective longitudinal evaluation of three different geriatric tools.
        J Gerontol A Biol Sci Med Sci. 2017; 72: 922-928
        • Schulkes K.J.G.
        • Souwer E.T.D.
        • van Elden L.J.R.
        • Codrington H.
        • Van Der Sar-van der Brugge S.
        • Lammers J.J.
        • et al.
        Prognostic value of geriatric 8 and identification of seniors at risk for hospitalized patients screening tools for patients with lung cancer.
        Clin Lung Cancer. 2017; 18: 660-666
        • Agemi Y.
        • Shimokawa T.
        • Sasaki J.
        • Miyazaki K.
        • Misumi Y.
        • Sato A.
        • et al.
        Prospective evaluation of the G8 screening tool for prognostication of survival in elderly patients with lung cancer: a single-institution study.
        PLoS One. 2019; 14e0210499
        • Kehl K.L.
        • Lathan C.S.
        • Johnson B.E.
        • Schrag D.
        Race, poverty, and initial implementation of precision medicine for lung cancer.
        J Natl Cancer Inst. 2019; 111: 431-434
        • Carre R.
        • Gervais R.
        • Guisier F.
        • TassyL Vinas F.
        • Lamy R.
        • et al.
        Octogenarians with EGFR-mutated non-small cell lung cancer treated by tyrosine-kinase inhibitor: a multicentric real-world study assessing tolerance and efficacy (OCTOMUT study).
        Oncotarget. 2018; 9: 8253-8262
        • Mohile S.G.
        • Mohamed M.R.
        • Xu H.
        • Culakova E.
        • Loh K.P.
        • Magnuson A.
        • et al.
        Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
        Lancet. 2021; 398: 1894-1904
        • Li D.
        • Sun C.L.
        • Kim H.
        • Soto-Perez-de-Celis E.
        • Chung V.
        • Koczywas M.
        • et al.
        Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: a randomized clinical trial.
        JAMA Oncol. 2021; 7e214158