The VES-13 screening tool predicted survival and treatment problems in older adults with cancer

Design

Systematic review and meta-analysis

Population

36 studies, 7,110 patients with cancer aged 65 and over

Primary outcome

Diagnostic accuracy for geriatric assessment abnormalities; overall and progression-free survival; adverse events

Effect

Diagnostic OR 1.93 (95% CI 1.66 to 2.19); overall survival HR 1.68 (1.53 to 1.84); adverse events OR 4.29 (1.39 to 13.23)

The Vulnerable Elders Survey-13 is a short tool for identifying patients aged 65 and over at risk of adverse outcomes who may need comprehensive geriatric assessment. This systematic review and meta-analysis of 36 studies with 7,110 patients with cancer examined its diagnostic and prognostic value.

For identifying abnormalities on comprehensive geriatric assessment the diagnostic odds ratio was 1.93 (95% CI 1.66 to 2.19), which the authors describe as moderate accuracy. High scores predicted worse overall survival (HR 1.68, 95% CI 1.53 to 1.84) but not progression-free survival (HR 1.28, 0.85 to 1.94). High scores were associated with more adverse events (pooled OR 4.29, 95% CI 1.39 to 13.23) and dose reduction (pooled OR 2.24, 1.15 to 4.37).

A diagnostic odds ratio near 2 is modest, so the tool is a triage step and not a replacement for full assessment, and the wide interval for adverse events suggests variation between studies. It supports using a brief screen to decide who gets the fuller evaluation.

• High VES-13 scores predicted worse overall survival (HR 1.68, 95% CI 1.53 to 1.84).
• They did not clearly predict progression-free survival.
• High scores were linked to more adverse events (OR 4.29) and dose reduction (OR 2.24).
• Accuracy for detecting geriatric assessment abnormalities was only moderate (diagnostic OR 1.93).
• Use VES-13 to prompt fuller assessment, not to withhold treatment.

Why it matters

Oncology clinics need a quick way to decide who needs a geriatric review.

Don't overread it

A screening score that predicts outcomes does not show that acting on it improves them.

The statistics, in plain English

A diagnostic odds ratio of 1.93 means the test separates patients with and without assessment abnormalities only modestly. The adverse-event odds ratio of 4.29 has a very wide interval (1.39 to 13.23), so the size of that association is uncertain.

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