The SAKK cancer-specific geriatric assessment (C-SGA): a pilot study of a brief tool for clinical decision-making in older cancer patients
- Equal contributors
1 Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, Bern CH-3012, Switzerland
2 Section of Geriatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
3 Division of Geriatrics, Department of General Internal Medicine, Inselspital University Hospital and University of Bern, Bern, Switzerland
4 Swiss Group for Clinical Cancer Research, SAKK Coordinating Centre, Bern, Switzerland
5 Kantonsspital Graubünden, Chur, Switzerland
6 Oncology-Haematology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
7 Department of Internal Medicine, Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
BMC Medical Informatics and Decision Making 2013, 13:93 doi:10.1186/1472-6947-13-93Published: 23 August 2013
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.
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 Graubünden (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.
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.
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.