VES-13 flags older people with cancer who need full geriatric assessment

Design

Systematic review and meta-analysis of 36 studies

Population

7110 patients aged 65 and over with cancer

Primary outcome

Accuracy for abnormal geriatric assessment; prediction of survival and toxicity

Effect

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 self-report screen for people aged 65 and over. A JAMDA meta-analysis pooled 36 studies (7110 patients) with cancer to test how well it identifies abnormalities on comprehensive geriatric assessment and predicts outcomes.

Diagnostic accuracy for an abnormal geriatric assessment was moderate (diagnostic odds ratio 1.93). A high score predicted worse overall survival (HR 1.68, 95% CI 1.53 to 1.84), more adverse events during treatment (OR 4.29) and more dose reductions (OR 2.24), but not progression-free survival.

VES-13 is a sorting tool, not a substitute for assessment. In a busy oncology or geriatric clinic, it can identify who most needs the full assessment before chemotherapy is planned.

• Use VES-13 or a similar short screen before cancer treatment in people aged 65 and over.
• Arrange comprehensive geriatric assessment for those who screen positive, before treatment is finalised.
• Expect more toxicity and dose reductions in high scorers and plan supportive care accordingly.
• Do not use a negative screen alone to rule out vulnerability; accuracy was only moderate.

Why it matters

It gives oncology teams a quick way to find older patients likely to struggle with treatment toxicity.

Don't overread it

Accuracy was moderate; VES-13 identifies who needs assessment, it does not replace it.

The statistics, in plain English

A hazard ratio of 1.68 means death occurred about two-thirds more often over time in high scorers. A diagnostic odds ratio of 1.93 indicates modest discrimination — useful for prioritising, not for ruling in or out.

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