4种衰弱识别工具在老年癌症患者中的应用比较

Comparison of four frailty screening tools in elderly cancer patients

目的比较4种衰弱工具对老年癌症患者衰弱风险的筛查能力,为临床衰弱筛查工具的选择提供参考。方法采用目的抽样法,选取308例住院老年癌症患者为研究对象,采用老年-八项问卷、弱势老年人调查-13问卷、简明老年人综合评估问卷、衰弱表型和老年综合评估工具进行衰弱评价。以老年综合评估结果为衰弱诊断金标准,通过Bayes判别分析和受试者工作特征曲线分析比较4种筛查工具筛查老年癌症患者衰弱风险的能力。结果老年癌症患者衰弱的发病率为46.10%~70.45%。老年-八项问卷、弱势老年人调查-13问卷、简明老年人综合评估问卷、衰弱表型与老年综合评估一致性比较的Kappa值分别是0.599、0.813、0.711和0.928(均P<0.05);对老年癌症患者衰弱风险预测的交叉验证准确性分别为80.5%、90.6%、85.7%和96.4%;受试者工作特征曲线下面积分别为0.867、0.943、0.853和0.976。结论4种工具筛查老年癌症患者衰弱风险的能力由高到低分别为衰弱表型、弱势老年人调查-13问卷、简明老年人综合评估问卷、老年-八项问卷。鉴于工具的筛查性能和临床应用便捷度,弱势老年人调查-13问卷可广泛应用于老年癌症患者的衰弱筛查。

Objective To compare the efficacy of 4 frailty screening tools in elderly cancer patients,and provide a basis for selection of appropriate frailty screening tools in clinical settings.Methods A total of 308 hospitalized elderly cancer patients were selected by purposive sampling method,and were assessed for frailty by using the Geriatric 8,the Vulnerable Elders Survey-13,the Abbreviated Comprehensive Geriatric Assessment,the Frailty Phenotype and the Comprehensive Geriatric Assessment,respectively.With the results of Comprehensive Geriatric Assessment being used as the gold standard for frailty diagnosis,the results of 4 screening tools were compared against the gold standard by running Bayes discriminant analysis and Receiver Operating Characteristic(ROC)analysis,in a bid to determine the frailty screening efficacy of the tools in elderly cancer patients.Results The prevalence of frailty in elderly cancer patients ranged from 46.10%to 70.45%.The consistency of frailty screening results yielded from the Ge-riatric 8,Vulnerable Elders Survey-13,Abbreviated Comprehensive Geriatric Assessment,and Frailty Phenotype,respectively against the frailty results of Comprehensive Geriatric Assessment generated a Kappa value of 0.599,0.813,0.711 and 0.928,respectively(all P<0.05).Cross validation accuracy for predicting frailty risk by the 4 tools was 80.5%,90.6%,85.7%and 96.4%,respectively.The area under the ROC curve was 0.867,0.943,0.853 and 0.976,respectively.Conclusion The Frailty Phenotype has the highest frailty screening efficacy,followed by the Vulnerable Elders Survey-13,the Abbreviated Comprehensive Geriatric Assessment,and the Geriatric 8 in descending order.Courtesy of excellent screening efficacy and easiness to use in clinical settings,the Vulnerable Elders Survey-13 is recommended for frailty screening in elderly cancer patients.