The Vulnerable Elders Survey-13 in cancer: moderate accuracy as a screen, useful as a prognostic flag

Design

Systematic review and meta-analysis of 36 studies

Population

7,110 patients aged 65 and over with cancer

Primary outcome

Diagnostic accuracy for geriatric assessment abnormalities, and prognostic value for survival and adverse events

Effect

Diagnostic OR 1.93 (95% CI 1.66 to 2.19); overall survival HR 1.68 (1.53 to 1.84)

This meta-analysis pooled 36 studies (7,110 patients) of the Vulnerable Elders Survey-13 (VES-13), a short screening tool for adults aged 65 and over, in people with cancer. It looked at whether the score identifies abnormalities on comprehensive geriatric assessment and whether it predicts outcomes.

Diagnostic accuracy for abnormal geriatric assessment was moderate (diagnostic odds ratio 1.93, 95% CI 1.66 to 2.19). A high score predicted worse overall survival (HR 1.68, 95% CI 1.53 to 1.84) but did not significantly predict progression-free survival (HR 1.28, 95% CI 0.85 to 1.94). High scores also went with more adverse events (pooled OR 4.29, 95% CI 1.39 to 13.23) and dose reductions (OR 2.24, 95% CI 1.15 to 4.37).

A moderate-accuracy screen should prompt, not replace, a full geriatric assessment. The wide interval on adverse events reflects few studies and disparate definitions.

• Use a short screen such as VES-13 to prioritise who gets a full geriatric assessment before cancer treatment.
• Do not use a screen result to withhold cancer treatment.
• Expect higher rates of adverse events and dose reduction with a high score.
• Do not rely on a normal screen to exclude geriatric problems.
• Plan supportive care and monitoring for patients with a high score.

Why it matters

Many oncology services cannot give everyone a full geriatric assessment, so the screening tool matters.

Don't overread it

Heterogeneous studies; the tool predicted overall survival but not progression-free survival, and it does not show that acting on the score improves outcomes.

The statistics, in plain English

A diagnostic odds ratio of 1.93 is modest: a test needs a ratio well above that to be good at separating people with and without abnormalities. A hazard ratio of 1.68 for survival means about two-thirds higher rate of death over follow-up with a high score, though studies adjusted for different factors.

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