Relationship between clinical outcomes and Dutch frailty score among elderly patients who underwent surgery for hip fracture. Clin Interv Aging. Frailty assessment in older adults undergoing interventions for peripheral arterial disease. Frailty as a predictor of surgical outcomes in older patients. Mortality, geriatric, and nongeriatric surgical risk factors among the eldest old: a Prospective Observational Study. A comparison of two preoperative frailty models in predicting postoperative outcomes in geriatric general surgical patients.
World J Surg. Frailty as a predictor of hospital length of stay after elective total joint replacements in elderly patients. BMC Musculoskelet Disord. Ann Surg. In press. The association of peri-operative scores, including frailty, with outcomes after unscheduled surgery. Prevalence of frailty and its association with mortality in general surgery. Am J Surg. The predictive value of the clinical frailty scale on discharge destination and complications in older hip fracture patients.
J Orthop Trauma. Preoperative frailty assessment predicts loss of independence after vascular surgery. Frailty is associated with postoperative complications in older adults with medical problems.
FRAIL questionnaire screening tool and short-term outcomes in geriatric fracture patients. The Association of frailty with outcomes and resource use after emergency general surgery: a Population-Based Cohort Study. Association of frailty and 1-year postoperative mortality following major elective noncardiac surgery: a Population-Based Cohort Study. A comparison of three frailty indices in predicting morbidity and mortality after on-pump aortic valve replacement. Determinants of length of stay after operative treatment for femur fractures.
Impact of frailty on outcomes in surgical patients: a systematic review and meta-analysis. Modified frailty index is an effective risk assessment tool in primary total hip arthroplasty. J Arthroplasty. Preoperative frailty increases risk of nonhome discharge after elective vascular surgery in home-dwelling patients. Ann Vasc Surg. Simplified frailty index to predict adverse outcomes and mortality in vascular surgery patients. Association of a frailty screening initiative with postoperative survival at 30, , and days.
Preoperative risk analysis index for frailty predicts short-term outcomes after hepatopancreatobiliary surgery. HPB Oxford. Preoperative frailty predicts postoperative complications and mortality in urology patients. World J Urol. Preoperative frailty risk analysis index to stratify patients undergoing carotid endarterectomy. Frailty in older adults: a nationally representative profile in the United States.
Suskind AM, Finlayson E. A call for frailty screening in the preoperative setting. The physical and biological characterization of a frail mouse model. Measuring frailty in clinical practice: a comparison of physical frailty assessment methods in a geriatric out-patient clinic.
Gurlit S, Gogol M. Prehabilitation is better than cure. Curr Opin Anaesthesiol. Integrating frailty research into the medical specialties-report from a U13 conference. Comprehensive geriatric assessment. Helping your elderly patients maintain functional well-being. Postgrad Med. Solomon DH. Geriatric assessment: methods for clinical decision making. A prehabilitation program for physically frail community-living older persons.
Arch Phys Med Rehabil. Association of a cancer diagnosis with vulnerability and frailty in older medicare beneficiaries. J Natl Cancer Inst. Frailty and cancer: implications for oncology surgery, medical oncology, and radiation oncology.
CA Cancer J Clin. Implications of sarcopenia in major surgery. Nutr Clin Pract. Support Center Support Center. External link. Please review our privacy policy. Brief Frailty Instrument Rockwood 15 Scale: 0—3, increasing frailty with increasing score.
Quantify deficits in an individual, divide by the total number of deficits taken into consideration. Groningen Frailty Indicator Steverink 16 Scale: 0— Physical Frailty Phenotype Fried et al 3 Scale: 0—5. Vulnerable Elders Survey Saliba et al 17 Clinical Frailty Scale Rockwood et al 18 Physician assigns score based on clinical judgment, comorbidity, and function A multidisciplinary team performs a secondary review and scoring.
Edmonton Frail Scale Rolfson et al 19 Ambulation Fatigue Illnesses Resistance Weight loss. Frail: any one of these diagnoses are present. Emergency surgery Elective orthopedic procedure 5. Hip fracture Vascular surgery Elective surgery 39 , General surgery Elective general surgery Elective joint replacement Emergency surgery 43 , Elective noncardiac surgery Orthopedic surgery Major elective noncardiac surgery Aortic Valve replacement Elective surgery Femur fracture Total hip arthroplasty Vascular surgery 6 , 38 , 56 , Data Availability: The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings.
This manuscript adheres to the appropriate reporting guidelines and community standards for data availability; Any related manuscripts currently in press or under consideration elsewhere are mentioned in the cover letter and will be uploaded as part of your submission as a related manuscript; Any persons named in the Acknowledgments section of the manuscript, or referred to as the source of a personal communication, have agreed to being so named; All authors have read, and confirm that they meet, ICMJE criteria for authorship; All contributing authors are aware of and agree to the submission of this manuscript.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Cancer occurs predominantly in the older population, yet patients over 60 years are significantly under-represented in clinical trials in oncology [1] , [2]. Consequently, oncologists are confronted with the paucity of clear therapeutic directives, and older patients are often offered reduced treatments and face worse outcomes [3] , including an increased risk of toxicity or even early death [4].
With growing numbers of older cancer patients, and considerable heterogeneity among them, effective tools are required for oncologists to better define the trade-off between treatment benefits and toxicity risk. Several recent reports have strongly suggested that different components of comprehensive CGA or multidimensional geriatric assessment MGA can be useful in oncology to predict early death [4] , functional decline [5] , toxicity [6] , [7] and ultimately survival [8] — [10] , and to adapt cancer treatment [11].
The likely reason is that it is time- and resource-consuming, which makes it unaffordable for community and small cancer hospitals. Furthermore, true CGA in contrast to MGA which involves the administration of a range of assessments is conducted by an experienced geriatrician who interprets and can act upon the MGA results, and geriatricians are rarely available in most cancer treatment structures.
This has made the development of shortened instruments essential [13] , [14]. To be acceptable for the whole community, such instruments should be performed quickly less than 10 min by a nurse or physician trained for the tool completion, but not necessarily trained in geriatrics.
In response to a French National Cancer Institute INCa call for proposal, and following escalating appeals for validated geriatric screening tools [15] — [17] , we developed the G8 screening tool to identify older cancer patients requiring geriatric assessment.
The G8 tool originated from a regional multicenter prospective cohort of cancer patients treated by first-line chemotherapy [18] , [19]. Secondary objectives included assessing the diagnostic accuracy of G8 in specific sub-populations, the diagnostic accuracy of VES and comparing it to that of G8, the within-patient reproducibility of both tests, and the prognostic value of both tests in terms of 1-year survival. Additional exploratory analyses included the assessment of the diagnostic accuracy of G8 and VES using a modified reference test at least two MGA tests with abnormal scores , and sensitivity analyses to assess the impact of missing questionnaires in the definition of the reference test.
Patients with known central nervous system metastases were excluded. At the first visit after enrollment, patients received a full clinical examination and completed the G8 test with a nurse, a clinical research assistant CRA , or a physician. The total score ranges from 0 to 17, with lower scores indicating a higher risk of impairments. The G8 questionnaire is provided in S1 Appendix. VES is a self-administered questionnaire that was completed during the first visit after enrollment.
For three pre-identified centers, patients also filled in the questionnaire at the following geriatric visit. VES consisted of four groups of questions: age, self-perceived health, difficulties to perform six specific activities, and difficulties to perform daily living tasks due to health concerns.
G8 results were blinded to both the geriatrician and the nurse. The reference test was defined as normal if scores for the seven instruments were available and normal. We defined the following populations: the included population, the eligible population, and the eligible and evaluable population. The included population corresponded to all patients included, regardless of eligibility and availability of G8 and MGA results.
The eligible population included all patients who did not violate any eligibility criteria. The required sample size was estimated based on our preliminary work [18]. The study population was described in terms of clinical and demographic characteristics with counts and percentages for qualitative variables and summary statistics mean and variance where appropriate; percentiles otherwise for quantitative variables. Reproducibility analysis was based on estimation of the Kappa agreement statistics for dichotomous data normal v abnormal score [22].
Reproducibility of G8 was assessed by comparing the score on the actual G8 with the scores extracted from the corresponding seven questions of MNA completed during the MGA for all patients. Reproducibility of VES was assessed based on a subgroup of patients included in three pre-identified centers who completed the questionnaire on two occasions. A priori sample size estimation suggested that enrollment of at least subjects would ensure sufficient precision to estimate the reproducibility of VES in this subgroup.
The prognostic value of the screening tools was assessed by analyzing one-year overall survivals using a Cox proportional hazards model. An exploratory model was also calculated examining the prognostic value of the reference test MGA score.
Results are presented according to the STARD guidelines [23] for reporting of studies of diagnostic accuracy, and the study protocol is available in S2 Appendix.
Initial exclusion of 77 ineligible patients left patients eligible population. A further patients were excluded from analyses due to protocol violations, participation withdrawals, missing G8 or MGA Fig.
Delay between G8 and MGA exceeded 37 days in 15 cases, and G8 was inadequately completed by three patients. The final eligible and evaluable population for the principal analyses consisted of patients with a median age of 78 years and of whom Patients were mostly seen in first consultations by a medical oncologist After the first enrollments, we convened an international independent data monitoring committee to examine recruitment across different tumor sites and discuss initial statistical hypotheses.
No modification was proposed by the committee of experts. On average, it took one hour to complete the MGA overall Almost all Rates of completion varied across instruments from The proportion of patients with abnormal scores varied from Overall, This was determined for the large majority of patients , For the remaining patients For 85 of these patients, although at least one score was missing, the score on one of the remaining instruments was abnormal so their reference test was considered impaired.
For the remaining 35 patients with only five or six available scores, all available scores were normal. Their reference test was considered to be impaired for the purposes of the main analyses see further discussion and analyses in results. Of the patients overall with altered scores, Proportions of subjects with at least one impaired score varied across disease stage At least one geriatric intervention was proposed by the geriatrician at the end of MGA in The most frequently proposed interventions were nutritional support patients, It took an average of 4.
The final G8 scores ranged from 1. The proportions of patients with impaired G8 scores varied according to disease stage The diagnostic accuracy of G8 is outlined in Table 3. G8 sensitivity was G8 was abnormal in Overall, patients with Grade comorbidities had normal G8 scores; this included mainly patients with one severe comorbidity Among false negative results, Sensitivity and specificity varied significantly according to tumor site: the sensitivity for prostate cancer patients was A subgroup analysis explored the influence of the presence or absence of at least one treatment in the last three months.
G8 sensitivity or specificity did not appear to be particularly affected by this factor. On average, it took 5. VES showed impaired scores in Sensitivity and specificity were VES was abnormal in The physical and disability questions are useful, but all other screening instruments miss too many cases.
Full text links Read article at publisher's site DOI : References Articles referenced by this article 24 A case for geriatric oncology.
An attempt to correlate a "Multidimensional Geriatric Assessment" MGA , treatment assignment and clinical outcome in elderly cancer patients: results of a phase II open study. Adjuvant chemotherapy in the elderly: whom to treat, what regimen? Step by step development of clinical care pathways for older cancer patients: necessary or desirable? A practical approach to geriatric assessment in oncology.
Comprehensive geriatric assessment for older patients with cancer. A practical method for grading the cognitive state of patients for the clinician. Development and validation of a geriatric depression screening scale: a preliminary report. Contribution of the geriatrician to the management of cancer in older patients. Show 10 more references 10 of Smart citations by scite.
The number of the statements may be higher than the number of citations provided by EuropePMC if one paper cites another multiple times or lower if scite has not yet processed some of the citing articles. Explore citation contexts and check if this article has been supported or disputed. Preoperative Evaluation of the Frail Patient. Frailty screening in dermato-oncology practice: a modified Delphi study and a systematic review of the literature.
Frailty in geriatric head and neck cancer: A contemporary review. Faculty Opinions. Similar Articles To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation. A pilot study of the vulnerable elders survey compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation. Four screening instruments for frailty in older patients with and without cancer: a diagnostic study.
The abbreviated comprehensive geriatric assessment aCGA : a retrospective analysis. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review.
Joining Europe PMC. Tools Tools overview. ORCID article claiming. Journal list. Grant finder. External links service. Annotations submission service. Developers Developer resources. API case studies.
0コメント