The Development of Geriatric Assessment and Intervention Guidelines for an Online Geriatric Assessment Tool: A Canadian Modified Delphi Panel Study

Virtual geriatric and frailty assessment for older adults with cancer

PURPOSE OF REVIEW

Since SARS-CoV2 pandemic, many specialties have introduced virtual assessments within clinical practice. Conducting an online geriatric assessment, or relying on self-reported questionnaires, may be more challenging than a conventional medical appointment. This review aims to discuss the state of research on virtual assessment and self-reported questionnaires in the general geriatric population and specifically in Oncology.

RECENT FINDINGS

Virtual assessment of older adults has been the focus of two separate position papers. Aside from videoconferences or phone appointments, self-reported questionnaires have emerged in recent years as reliable tools to screen for frailty and triage patients who would benefit from a comprehensive in-person assessment, with adequate correlation with in-person tests, good acceptance by the respondents and being well received by healthcare providers. Although some have been tried in geriatric oncology, many still lack validation, and their widespread use may be limited by digital literacy, cognitive impairment, and social supports.

SUMMARY

The development, validation and adoption of self-reported questionnaires and virtual assessment in the care of older adults with cancer may overcome the staffing limitations and time constrains that frequently hampers the widespread evaluation of this population to improve their care.

Performance of the SARC-F in identifying low grip strength and physical performance in older adults with cancer

INTRODUCTION

Remote, online geriatric assessment (GA) is gaining attention in oncology. Most GA domains can be assessed remotely. However, there is limited evidence identifying reliable tools that can be used in lieu of objective measures of physical function, such as grip strength and physical performance during remote, online GA. In this prospective cohort study, we aimed to assess the performance of the SARC-F, a screening questionnaire for sarcopenia, in identifying low grip strength and the Short Physical Performance Battery (SPPB). Additionally, we assessed the satisfaction of clinical staff with using the SARC-F in the clinic.

MATERIALS AND METHODS

Data were prospectively collected from older adults with cancer of any type and stage who underwent GA in the geriatric oncology clinic of a tertiary cancer centre. Following GA, patients were asked to complete the SARC-F tool. Spearman correlations were performed between objective measures of physical function, SARC-F domains, and SARC-F total score. Additionally, the sensitivity, specificity, positive predictive value, and negative predictive value were assessed to evaluate the performance of SARC-F to detect low grip strength and SPPB.

RESULTS

Eighty (n = 80) older adults (mean age: 80 years) with cancer completed the SARC-F. A positive SARC-F was found in 31.3% of the cohort. Moderate correlations were found between the SPPB per point and Assistance in walking (r = -0.69), as well as the SPPB per point and total SARC-F score (r = -0.66). SARC-F exhibited moderate sensitivity in identifying low grip strength using the Foundation for the National Institutes of Health (FNIH) criteria (sensitivity: 64.3%) or the Sarcopenia Definitions and Outcomes Consortium (SDOC) criteria (sensitivity: 40.4%). However, specificity was high (>75%) regardless of the criteria applied. Similarly, moderate sensitivity (52.2%), but excellent specificity (97.1%) was found for SPPB. When low grip strength per FNIH was combined with low SPPB, SARC-F demonstrated high sensitivity (80%) and specificity (75.7%).

DISCUSSION

SARC-F exhibited promising performance in identifying low grip strength per FNIH and low SPPB combined. To definitively assess the performance of the SARC-F in detecting low grip strength and SPPB, larger studies are warranted.