Frailty screening has no benefit over geriatric-assessment in elderly patients with solid tumors

According to a new study Frailty screening has no benefit over geriatric-assessment in elderly patients with solid tumors. The study conducted by Adolfo González Serrano and team found that frailty screening tests demonstrated acceptable diagnostic accuracy, but there were no clinical advantages over the geriatric-assessment-for-all approach.

The findings of this study were published in the Journal of Clinical Oncology.

The geriatric assessment (GA) might reveal age-related problems including frailty that were previously unnoticed. In elderly cancer patients, GA determines the choice of treatment, directs geriatric treatments, and forecasts mortality and chemotherapy side effects. The goal of frailty screening is to identify elderly people who need geriatric evaluation and to stop needless GA in healthy patients. This study was done in order to confirm the aforementioned claim since the sensitivity and specificity of screening tests are what these theories rely on, but they have not been validated.

Outpatients with prostate, breast, colorectal, or lung cancer who were under the age of 70 and participating in the ELCAPA cohort study between February 2007 and December 2019 underwent a cross-sectional analysis. On the basis of the GA findings, the diagnostic efficacy of the G8 Geriatric Screening Tool (G8) and modified G8 scores for detecting unsuitable people was assessed. In order to determine the value of frailty screening for identifying unfit patients and preventing needless GA in fit individuals across various threshold probabilities, decision curve analysis was utilized.

The key findings of this study were:

1. Among the 1,648 patients we included, 1,428 (87%) were deemed unsuitable (median age, 81 years).

2. For G8 and the modified G8 score, the sensitivity and specificity were 85% and 59%, respectively.

3. At a threshold probability of 0.25, the net benefit (NB) for decision curve analysis' identification of unsuitable individuals was 0.72 for G8, 0.72 for the modified G8, and 0.82 for GA.

4. The NBs were 0.71, 0.72, and 0.80 at a threshold probability of 0.33, respectively.

5. The NBs were 0.68, 0.69, and 0.73 at a threshold probability of 0.5, respectively.

6. At predetermined threshold probabilities, no screening tool decreased the need for needless GA in fit individuals.

In conclusion, frailty screening did not outperform a GA-for-all approach for identifying unfit patients or avoiding GA in fit patients, despite the screening instruments' high diagnostic accuracy. Improving decision-making for older cancer patients in busy practices with constrained staff members requires optimizing current frailty assessment tools and assessing their value with NB methodologies.

Reference:

González Serrano, A., Laurent, M., Barnay, T., Martínez-Tapia, C., Audureau, E., Boudou-Rouquette, P., Aparicio, T., Rollot-Trad, F., Soubeyran, P., Bellera, C., Paillaud, E., & Canouï-Poitrine, F. (2022). A Two-Step Frailty Assessment Strategy in Older Patients With Solid Tumors: A Decision Curve Analysis. In Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO). https://doi.org/10.1200/jco.22.01118