Number of Patients Alive, Assessable, and Dead at Each Study Point

<p>Data are from the French prospective multicentre CryptoA/D study. Pts, patients.</p

Flow chart of patients included in derivative cohort based on screening for participation in randomized controlled study and in validation cohort.

<p>Flow chart of patients included in derivative cohort based on screening for participation in randomized controlled study and in validation cohort.</p

ROC curves of predictive score among derivative population (A) and validation population (B) and respective calibration plots (C and D).

<p>Vertical bars correspond to 95%.</p

Screening for Vulnerability in Older Cancer Patients: The ONCODAGE Prospective Multicenter Cohort Study

<div><p>Background</p><p>Geriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13).</p><p>Patients and Methods</p><p>The diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate.</p><p>Results</p><p>Patient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, <i>P</i> =  0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, <i>P</i><0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival.</p><p>Conclusion</p><p>With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy.</p></div

Secondary analyses of diagnostic accuracy of G8 according to subgroups (n = 1435).

<p>*Positive (PPV) and Negative (NPV) predictive values; † Non-Hodgkin's Lymphoma; ** Upper Aero Digestive Tract; ^§Treatment in the last three months.</p><p>Secondary analyses of diagnostic accuracy of G8 according to subgroups (n = 1435).</p

Percentages of normal and abnormal scores on the reference standard Multidimensional Geriatric Assessment (MGA) instruments for eligible and evaluable patients (n = 1435) and for eligible patients.

<p>*ADL = activities of daily living; IADL = instrumental activities of daily living; GDS = geriatric depression score; MMSE = mini-mental state examination; MNA = mini nutritional assessment; CIRS-G = comorbidities rating scale – geriatrics; TGUG =  Timed Get Up and Go.</p><p>** Abnormal scores were defined per instrument as (for complete instruments): ADL ≤ 5/6, IADL ≤ 7/8, GDS15 ≥ 6/15, MMSE ≤ 23/30, MNA ≤ 23.5/30, CIRS-G presence of at least one comorbidity (excluding the cancer being treated), and TGUG> 20 seconds. Incomplete or unavailable instruments were considered abnormal.</p><p>Percentages of normal and abnormal scores on the reference standard Multidimensional Geriatric Assessment (MGA) instruments for eligible and evaluable patients (n = 1435) and for eligible patients.</p

Factors associated with one-year survival (univariate and multivariate models).

<p>*ECOG PS =  Eastern Cooperative Oncology Group Performance Status.</p><p>**Mx  =  Unknown.</p><p>Factors associated with one-year survival (univariate and multivariate models).</p

STARD flow diagram for patient enrollments and exclusions in the ONCODAGE G8 study.

<p>Footnote: *In total, ten G8 were incomplete, but six ‘abnormal’ scores were able to be imputed from the incomplete assessments.</p

Diagnostic accuracy of G8 and Vulnerable Elders Survey (VES-13)^* screening tools for identifying older patients who could benefit from Multidimensional Geriatric Assessment (MGA) for eligible and evaluable population (n = 1435).

<p>*The reference test is defined as one or more abnormal MGA tests; modified reference test is defined as 2 or more abnormal MGA tests.</p><p>**Vulnerable Elders survey 13 (French version) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0115060#pone.0115060-Saliba1" target="_blank">[44]</a>.</p><p>Diagnostic accuracy of G8 and Vulnerable Elders Survey (VES-13)^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0115060#nt107" target="_blank">*</a>} screening tools for identifying older patients who could benefit from Multidimensional Geriatric Assessment (MGA) for eligible and evaluable population (n = 1435).</p

Patient and tumor characteristics in the ONCODAGE project.

<p>*ECOG PS = eastern cooperative oncology group performance status.</p><p>**Recommendations of the Cancer Care Ontario Practice Guidelines Initiative were implemented.</p><p>***As part of the first-line treatment initially planned. More than one treatment possible.</p><p>Values are numbers (percentages) unless stated otherwise.</p><p>Patient and tumor characteristics in the ONCODAGE project.</p