G8 screening and health-care use in patients with cancer

The Geriatric 8 (G8) score, a widely used screening tool to assess frailty in older adults with cancer,1van Walree IC Scheepers E van Huis-Tanja L et al.A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer.J Geriatr Oncol. 2019; 10: 847-858Summary Full Text Full Text PDF PubMed Google Scholar is recommended by several guidelines.2Droz JP Albrand G Gillessen S et al.Management of prostate cancer in elderly patients: recommendations of a task force of the International Society of Geriatric Oncology.Eur Urol. 2017; 72: 521-531Summary Full Text Full Text PDF PubMed Scopus (142) Google Scholar In the past decade, geriatric frailty has been gaining attention as a consequence of the ageing global population. Ageing is increasing the demand for, and adding pressure to, already strained health-care systems and services worldwide. In The Lancet Healthy Longevity, Victoria Depoorter and colleagues3Depoorter V Vanschoenbeek K Decoster L et al.Long-term health-care utilisation in older patients with cancer and the association with the Geriatric 8 geriatric screening tool: a retrospective analysis using linked clinical and population-based data in Belgium.Lancet Healthy Longev. 2023; (published online June 13.)https://doi.org/10.1016/S2666-7568(23)00081-8Google Scholar report the results of a retrospective study of G8 screening that provides important insights on the subject. The findings are drawn from a cohort of more than 6000 Belgian patients, aged 70 years or older and with cancer diagnosed within the previous 6 months. Depoorter and colleagues report that compared with patients with a normal G8 score (>14 points), patients with an abnormal G8 score (≤14 points) required the use of health-care resources more frequently within the 3-year follow-up period: they had more hospital admissions (adjusted rate ratio 1·20 [95% CI 1·15–1·25]; p<0·0001), spent more days in hospital (1·66 [1·64–1·68]; p<0·0001), and had more emergency department visits (1·42 [1·34–1·52]; p<0·0001), intensive care days (1·49 [1·39–1·60]; p<0·0001), general practitioners contacts (1·19 [1·17–1·20]; p<·0001), and home care days (1·59 [1·58–1·60]; p<0·0001). The authors should be applauded for their approach, which is different from that of existing studies investigating correlations of the G8 score and other geriatric screening tools with patient outcomes after specific treatments.4Martinez-Tapia C Paillaud E Liuu E et al.Prognostic value of the G8 and modified-G8 screening tools for multidimensional health problems in older patients with cancer.Eur J Cancer. 2017; 83: 211-219Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 5Schulkes KJG Souwer ETD van Elden LJR et al.Prognostic value of Geriatric 8 and identification of seniors at risk for hospitalized patients screening tools for patients with lung cancer.Clin Lung Cancer. 2017; 18: 660-666Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 6Souwer ETD Verweij NM van den Bos F et al.Risk stratification for surgical outcomes in older colorectal cancer patients using ISAR-HP and G8 screening tools.J Geriatr Oncol. 2018; 9: 110-114Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar However, before any clinical implications can be ascribed to these data, a more in-depth analysis of the study and of the G8 score as a screening tool is needed. In this study, the only association identified was that of an abnormal G8 score with more frequent health-care resource use. This retrospective study was not designed to prove any predictive value of the G8 score, particularly because patients who died during the first 3 months of follow-up were excluded from the analysis and because a multivariate analysis for different influencing factors was not done. Of the 6391 patients included in the analysis, 4110 (64·3%) had an abnormal baseline G8 score and 2281 (35·7%) had a normal G8 score, a breakdown that matches findings in previous literature7Bouzan J Stoilkov B Nellas S Horstmann M Comparison of G8 and ISAR screening results in geriatric urology.Medicines. 2021; 8: 40Crossref Google Scholar and that implies that approximately two-thirds of screened patients were considered to be at risk of frailty. In health-care settings, the high number of abnormal G8 scores raises questions about how best to manage such patients, who will require further assessments and geriatric care. One of the possible reasons for the high number of patients with abnormal G8 test results at baseline is the low specificity of the G8 score, which can to be attributed to the dichotomous test design of the score and the low cutoff used (≤14 of 17 points). The G8 score was introduced in 2012 by Bellera and colleagues8Bellera CA Rainfray M Mathoulin-Pelissier S et al.Screening older cancer patients: first evaluation of the G-8 geriatric screening tool.Ann Oncol. 2012; 23: 2166-2172Summary Full Text Full Text PDF PubMed Scopus (566) Google Scholar as a test with high sensitivity to identify older adults with cancer in need of comprehensive geriatric assessment, at the cost of a loss of specificity. However, in large screening cohorts, this approach produces a large number of potential false positives. This limitation is clear when considering the structure of the single items of the G8 score used to score indiviuals:9Bouzan J Nellas S Stoilkov B Willschrei P Horstmann M Item analysis of G8 screening in uro-oncologic geriatric patients.Int Urol Nephrol. 2023; 55: 1441-1446Crossref PubMed Scopus (0) Google Scholar for example, in the polypharmacy item, one point is subtracted from the total score for patients who take more than three drugs, and in the age item, one or two points are subtracted from the total score for patients older than 80 years, irrespective of their fitness. Furthermore, some geriatric impairments, such as in cognition, are poorly addressed by the G8 score.9Bouzan J Nellas S Stoilkov B Willschrei P Horstmann M Item analysis of G8 screening in uro-oncologic geriatric patients.Int Urol Nephrol. 2023; 55: 1441-1446Crossref PubMed Scopus (0) Google Scholar Although the G8 score has been validated in several oncological studies, questions remain as to whether it is the optimum screening tool for large cohorts, such as that of the present study by Depoorter and colleagues. Therefore, the G8 score must be considered only for what it is: a screening tool for the suspicion of geriatric frailty, but that does not permit a diagnosis of geriatric frailty (which can only be done using comprehensive geriatric assessments), as highlighted by Depoorter and colleagues in the limitations of their study. Overall, the key message of the study by Depoorter and colleagues is that an abnormal G8 score was associated with more frequency health-care use than a normal G8 score. These findings are notable and highlight the importance of geriatric screening and assessments for improved patient management in settings with limited health-care resources, and should motivate researchers to further improve geriatric screening by finding more accurate screening tools. We declare no competing interests. Long-term health-care utilisation in older patients with cancer and the association with the Geriatric 8 screening tool: a retrospective analysis using linked clinical and population-based data in BelgiumAn abnormal G8 score at cancer diagnosis was associated with increased health-care utilisation in the subsequent 3 years among patients who survived longer than 3 months. Full-Text PDF Open Access