Screening for Frailty May Improve Outcomes for Older Patients With Genitourinary Malignancies

Screening for frailty with the vulnerable elders survey (VES-13) may lead to improved outcomes for 65 older adults (OAs; aged 65 years and older) with genitourinary (GU) malignancies, according to results of a Canadian study presented at the 2020 Genitourinary Cancers Symposium, held in San Francisco, California. 

The researchers at the Princess Margaret Cancer Centre in Canada conducted a study with 77 patients and found that the VES-13 was able to identify vulnerable GU patients who would benefit from a comprehensive geriatric assessment (CGA). The VES-13 was also able to help predict treatment optimization by identifying patients at higher risk of chemotherapy toxicity and higher comorbidity.

VES-13 is a well-studied brief frailty screening tool for older adults in the oncology setting, but its effectiveness has never been fully investigated in patients with GU malignancies. The team sought to determine whether the VES-13 can help predict which older adults with bladder, prostate, or kidney malignancies had subsequent treatment modification after CGA. They also examined if there is any association between VES-13 score with comorbidity and the chemotherapy toxicity prediction tool (CARG).

The study included 77 consecutive patients with GU cancer referred to a geriatric oncology clinic between July 2015 and October 2019. All patients were screened with the VES-13 and underwent CGA, which assesses 8 domains including cognition, comorbidities, function, and risk for falls.

Fifty-two patients (67.5%) had a VES-13 score of 3 or higher. In addition, this group of patients had significantly higher comorbidities (P =.003) and worse CARG scores (P =.005). For the entire cohort, the final treatment had to be modified in 36 patients (47%).

On univariate analysis, the odds ratio (OR) for VES-13 score of 3 or higher was 1.92 for change in final treatment. However, this was not deemed to be statistically significant due to modest sample size. The authors noted a strong association between the final treatment plans and the risk for falls (OR 2.63), physical performance (OR 2.51), and cognition (OR 3.95).

Reference

AlQurini NM, Timilshina N, Jin R, et al. Does screening for frailty with the vulnerable elders survey (VES-13) identify older adults with GU malignancy who benefit most from a consultation in a geriatric oncology clinic? J Clin Oncol. 2020;38(suppl 6):abstr 209.