Comparing frailty screening tools for older head and neck cancer patients

Because of population aging, the management of older head and neck cancer (HNC) patients (pts) turns into a challenging clinical priority. Comprehensive Geriatric Assessment (CGA) is considered the gold standard tool to classify pts by their frailty profile in order to personalize treatment. As CGA is time- and resource-consuming, screening instruments have been developed in order to identify pts who are fit for standard treatment versus those in whom CGA should be done. This study compared the accuracy of two frailty-screening methods, the Vulnerable Elderly Survey (VES-13) and the Geriatric 8 (G8) with the CGA to detect fit pts for standard cancer plan. Consecutive older (≥70 years) HNC pts were prospectively included. VES-13 and G8 were performed in all pts at baseline and then assessed by a geriatrian to complete the CGA, which included the evaluation of comorbidities, polypharmacy, functional status, geriatric syndromes, mood and cognition and social status. Based on CGA results, pts were classified into fit (F), medium-fit (MF) and unfit (UF). We used original cut-off for the screening tools (VES-13 <3 and G8 >14) to identify F pts. We compared the ability of VES-13 and G8 to detect F pts according to CGA (vs MF and UF pts) using sensitivity (S), specificity (E), positive (PPV) and negative (NPV) predictive values. From January 2018 to March 2020, 124 older HNC pts were included: Median age was 80 years (range 71-96) and were mostly males (70.2%). Out of 68 (54.8%) pts considered F by VES-13; 48 (70.6%), 20 (29.4%) and 0 (0%) were classified as F, MF and UF, respectively by the CGA. Out of the 43 (34.7%) pts identified as F by G8, 35 (81.6%), 8 (18.6%) and 0 (%) were classified as F, MF and UF, respectively by the CGA. S, E, PPV and NPV of each screening tool for detecting F pts according to CGA were: VES-13 87.3%, 71%, 70% and 87.5%; G8 63.6%, 88.4%, 81.3% and 75.5%. Our data indicates that both tools showed reliable screening performance. G8 is better in predicting F pts according to CGA whereas VES13 has higher capacity to identify frail pts in need of CGA. Even though screening tools cannot replace CGA, they might be useful to select pts for CGA.