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

BackgroundRecommendations from international task forces on geriatric assessmentemphasize the need for research including validation of cancer-specificgeriatric assessment (C-SGA) tools in oncological settings. This study wasto evaluate the feasibility of the SAKK Cancer-Specific Geriatric Assessment(C-SGA) in clinical practice.MethodsA cross sectional study of cancer patients ≥ 65 years old(N = 51) with pathologically confirmed cancer presenting forinitiation of chemotherapy treatment (07/01/2009-03/31/2011) at two oncologydepartments in Swiss canton hospitals: Kantonsspital Graubünden (KSGRN = 25), Kantonsspital St. Gallen (KSSG N = 26).Data was collected using three instruments, the SAKK C-SGA plus physicianand patient evaluation forms. The SAKK C-SGA includes six measures coveringfive geriatric assessment domains (comorbidity, function, psychosocial,nutrition, cognition) using a mix of medical record abstraction (MRA) andpatient interview. Five individual domains and one overall SAKK C-SGA scorewere calculated and dichotomized as below/above literature-based cut-offs.The SAKK C-SGA was evaluated by: patient and physician estimated time tocomplete, ease of completing, and difficult or unanswered questions.ResultsTime to complete the patient questionnaire was considered acceptable byalmost all (≥96%) patients and physicians. Patients reported slightlyshorter times to complete the questionnaire than physicians(17.33 ± 7.34 vs.20.59 ± 6.53 minutes, p = 0.02). Bothgroups rated the patient questionnaire as easy/fairly easy to complete (91%vs. 84% respectively, p = 0.14) with few difficultor unanswered questions. The MRA took on average8.32 ± 4.72 minutes to complete. Physicians (100%)considered time to complete MRA acceptable, 96% rated it as easy/fairly easyto complete. Individual study site populations differed on health-relatedcharacteristics (excellent/good physician-rated general health KSGR 71%vs. KSSG 32%, p = 0.007). The overall mean C-SGAscore was 2.4 ± 1.12. Patients at KSGR had lower C-SGAscores (2.00 ± 1.19 vs.2.81 ± 0.90, p = 0.009) and a smallerproportion (28% vs. 65%, p = 0.008) was above the C-SGAcut-off score compared to KSSG.ConclusionsThese results suggest the SAKK C-SGA is a feasible practical tool for use inclinical practice. It demonstrated discriminative ability based on objectivegeriatric assessment measures, but additional investigations on use forclinical decision-making are warranted. The SAKK C-SGA also providesimportant usable domain information for intervention to optimize outcomes inolder cancer patients.