Use of Geriatric Screening Tools to Assess Older Patients With Cancer

The Geriatric 8

The G8 screening tool was developed to allow for screening patients more quickly and identifying areas that may need further evaluation with a full CGA. The G8 tool is a questionnaire with 8 questions, each scored individually. The total score ranges from 0 to 17. Answers to the questions are scored, and a patient is determined to be either high or low risk. The questions asked on the G8 include⁵:

• Has food intake decreased over the last 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties?
• Weight loss during the last 3 months?
• Mobility?
• Neuropsychological problems?
• BMI?
• Takes more than 3 prescription drugs per day?
• In comparison with other people of the same age, how does the patient consider their health status?
• Age?

Those whose score finds them to be at risk for specific impairments are suggested to undergo full CGA testing.⁵

Outcomes of the Study

In the recently published study, a total of 291 patients were administered the CGA and G8 tests before starting chemotherapy, immediately after finishing chemotherapy, and again 1 year later. Patients included those being treated for curative and palliative intents and had a variety of solid tumor and hematologic malignancies.³ 

The use of the CGA consisted of the Charlson comorbidity index, polypharmacy, ADL, IADL, geriatric depression scale-15, Mini-Mental State evaluation, and minimal nutrition assessment. Using these tools, patients were classified as either fit, vulnerable, or frail depending upon the results.³

The G8 screening tool referenced above was used, and patients with scores of 14 or less were high risk, and those with scores greater than 14 were low risk.³ 

The study found that patients who had a high-risk G8 score before starting chemotherapy were at higher risk for progressive disease or decline in IADL 1 year after treatment. They were also found to have shorter overall survival and stopped chemotherapy prematurely due to toxicity. These results were mostly seen in patients being treated with neoadjuvant or adjuvant chemotherapy for solid tumor malignancies. The CGA classification of fit, vulnerable, or frail didn’t show association with the same outcomes. The study also found that in at least half of the patients studied, the quality of life, IADL independence, and functional status were maintained following chemotherapy.³ 

Conclusions

The results of this study showed that using the G8 can provide a practical way for clinicians to help decision making about chemotherapy, especially for those patients who are being treated with neoadjuvant or adjuvant chemotherapy for solid tumors.³ 

References

1. Age and cancer risk. National Cancer Institute. Updated March 5, 2021. Accessed September 15, 2022. 
2. Mohile SG, Epstein RM, Hurria A, et al. Communication with older patients with cancer using geriatric assessment: a cluster-randomized clinical trial from the National Cancer Institute Community Oncology Research Program. JAMA Oncol. 2020;6(2):196-204. doi:10.1001/jamaoncol.2019.4728
3. Rier HN, Meinardi MC, van Rosmalen J, et al. Association between geriatric assessment and post-chemotherapy functional status in older patients with cancer. Oncologist. Published online July 21, 2022. doi:10.1093/oncolo/oyac131
4. Owusu C, Berger NA. Comprehensive geriatric assessment in the older cancer patient: coming of age in clinical cancer care. Clin Pract (Lond). 2014;11(6):749-762. doi:10.2217/cpr.14.72 
5. Bellera CA, Rainfray M, Mathoulin-Pélissier S, et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;23(8):2166-2172. doi:10.1093/annonc/mdr587.