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Short Screening Tools

Chapter 3 - Evaluation of the Senior Cancer Patient: Comprehensive Geriatric Assessment and Screening Tools for the Elderly

These are rapid triage tools containing questions which only take a few minutes to answer. They can be used broadly to screen which older patients will need further work-up. For example, all new patients aged 70 and older are routinely screened in our clinic.

The International Society of Geriatric Oncology (SIOG) has recently published an extensive systematic review of the tools available, including a copy of each of those instruments (Appendix D). This chapter gives a short summary of the conclusions regarding the clinical use of these tools. The review identified 44 studies reporting on the use of 17 different screening tools in older cancer patients. The tools most studied in these patients are the G8, the Flemish version of the Triage Risk Screening Tool (fTRST) and the Vulnerable Elders Survey-13 (VES-13).

The validity of most tools was tested against a multidimensional assessment with geriatric instruments, or an assessment by a geriatrician.

Across all studies, the highest sensitivity was observed for: G8, fTRST, Oncogeriatric screen, Study of Osteoporotic Fractures, Eastern Cooperative Oncology Group-Performance Status, Senior Adult Oncology Program (SAOP) 2 screening and Gerhematolim.

In 11 direct comparisons (comparing two or more screening tools) for detecting problems on a full geriatric assessment (GA), the G8 was more or equally sensitive than other instruments in six comparisons, whereas results were mixed for the VES-13 in seven comparisons.

None of these tools are very specific and, therefore, if positive, they need to be supplemented by a more complete GA. However, they can help to focus geriatric resources towards those patients who need them most.

Practical Tips

Review a few of the tested tools and choose the one best adapted to your clinical setting. For example, a short tool filled out by patients, such as the G8, is probably best if you want many clinics to test all older patients for referral to a multidisciplinary clinic. On the other hand, if you have a multidisciplinary clinic where team members can assess the patients at first visit, a slightly more extensive tool, such as the SAOP2, can help you identify more precisely which team members to involve. Most screenings can be patient-answered or included in the initial nursing assessment.

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