BMC Med Inform Decis Mak - The SAKK cancer-specific geriatric assessment (C-SGA): a pilot study of a brief tool for clinical decision-making in older cancer patients.


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CKGROUND: Recommendations from international task forces on geriatric assessment emphasize the need for research including validation of cancer-specific geriatric assessment (C-SGA) tools in oncological settings. This study was to evaluate the feasibility of the SAKK Cancer-Specific Geriatric Assessment (C-SGA) in clinical practice.METHODS: A cross sectional study of cancer patients =65 years old (N=51) with pathologically confirmed cancer presenting for initiation of chemotherapy treatment (07/01/2009-03/31/2011) at two oncology departments in Swiss canton hospitals: Kantonsspital Graub?nden (KSGR N=25), Kantonsspital St. Gallen (KSSG N=26). Data was collected using three instruments, the SAKK C-SGA plus physician and patient evaluation forms. The SAKK C-SGA includes six measures covering five geriatric assessment domains (comorbidity, function, psychosocial, nutrition, cognition) using a mix of medical record abstraction (MRA) and patient interview. Five individual domains and one overall SAKK C-SGA score were calculated and dichotomized as below/above literature-based cut-offs. The SAKK C-SGA was evaluated by: patient and physician estimated time to complete, ease of completing, and difficult or unanswered questions.RESULTS: Time to complete the patient questionnaire was considered acceptable by almost all (=96%) patients and physicians. Patients reported slightly shorter times to complete the questionnaire than physicians (17.33?7.34 vs. 20.59?6.53 minutes, p=0.02). Both groups rated the patient questionnaire as easy/fairly easy to complete (91% vs. 84% respectively, p=0.14) with few difficult or unanswered questions. The MRA took on average 8.32?4.72 minutes to complete. Physicians (100%) considered time to complete MRA acceptable, 96% rated it as easy/fairly easy to complete. Individual study site populations differed on health-related characteristics (excellent/good physician-rated general health KSGR 71% vs. KSSG 32%, p=0.007). The overall mean C-SGA score was 2.4?1.12. Patients at KSGR had lower C-SGA scores (2.00?1.19 vs. 2.81?0.90, p=0.009) and a smaller proportion (28% vs.65%, p=0.008) was above the C-SGA cut-off score compared to KSSG.CONCLUSIONS: These results suggest the SAKK C-SGA is a feasible practical tool for use in clinical practice. It demonstrated discriminative ability based on objective geriatric assessment measures, but additional investigations on use for clinical decision-making are warranted. The SAKK C-SGA also provides important usable domain information for intervention to optimize outcomes in older cancer patients.

Resumo Limpo

ckground recommend intern task forc geriatr assess emphas need research includ valid cancerspecif geriatr assess csga tool oncolog set studi evalu feasibl sakk cancerspecif geriatr assess csga clinic practicemethod cross section studi cancer patient year old n patholog confirm cancer present initi chemotherapi treatment two oncolog depart swiss canton hospit kantonsspit graubnden ksgr n kantonsspit st gallen kssg n data collect use three instrument sakk csga plus physician patient evalu form sakk csga includ six measur cover five geriatr assess domain comorbid function psychosoci nutrit cognit use mix medic record abstract mra patient interview five individu domain one overal sakk csga score calcul dichotom belowabov literaturebas cutoff sakk csga evalu patient physician estim time complet eas complet difficult unansw questionsresult time complet patient questionnair consid accept almost patient physician patient report slight shorter time complet questionnair physician vs minut p group rate patient questionnair easyfair easi complet vs respect p difficult unansw question mra took averag minut complet physician consid time complet mra accept rate easyfair easi complet individu studi site popul differ healthrel characterist excellentgood physicianr general health ksgr vs kssg p overal mean csga score patient ksgr lower csga score vs p smaller proport vs p csga cutoff score compar kssgconclus result suggest sakk csga feasibl practic tool use clinic practic demonstr discrimin abil base object geriatr assess measur addit investig use clinic decisionmak warrant sakk csga also provid import usabl domain inform intervent optim outcom older cancer patient

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