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A B S T R A C T S
be apparent to clinicians. Patients scoring 3 or greater are
considered to be at higher risk for adverse outcomes (Lillian
et al., J Am Geriatr Soc, 2006) and may benefit from a referral
to the Geriatric Oncology (GO) clinic. Most patients seen in
genitourinary (GU) oncology clinics are older adults, but data
are limited on the performance of the VES-13 in identifying
older GU patients with geriatric issues or syndromes.
Objectives:
To examine whether the VES-13 score differen-
tiates among new older GU cancer patients with or without
geriatric issues and syndromes.
Methods:
The VES-13 screening was implemented in July
2015 for all new patients with a GU cancer diagnosis who are
75 years of age or older. Independent of VES-13 score, patients
could be referred to the GO clinic for assessment based on age
(75+) and medical complexity or clinician concern. Patients
were stratified into those with low or high VES-13 scores and
abnormalities in Comprehensive Geriatric Assessment (CGA)
domains (cognitive impairment, comorbidities, functional
impairment, falls risk, medication issues, social vulnerability,
malnutrition, and depression) were collected prospectively.
Descriptive statistics were used to describe the VES-13 scores
and CGA results.
Results:
From July 2015-May 2016, 53 patients completed
the VES-13 in the GO clinic. 15/53 (28%) scored low (0-2)
and 38/53 (72%) scored high (
3). High VES-13 scores were
associated with a greater proportion of abnormalities in every
CGA domain (Table 1). Of these 53 patients, 2 patients with a
low VES-13 score and 3 patients with a high VES-13 score had
their existing oncologic treatment plans changed after being
assessed in the GO clinic, whereas 0 patients and 4 patients
with a low and high VES-13 score without existing treatment
plans, respectively, had their plans finalized after the GO
clinic.
Table 1 (abstract P127) – Performance of the VES-13 in predicting
abnormalities in geriatric domains and presence of geriatric
syndromes
VES-13
VES-13
Low score
High score
Domain
(0-2) N=15
(3-10) N=38
Physical Frailty (SPPB/Grip)
6 (40.0%)
37 (97.4%)
Cognitive Impairment (Mini-Cog)
4 (26.7%)
20 (52.6%)
Comorbidities (Charlson Index)
6 (40.0%)
21 (55.3%)
Functional Impairment (OARS IADLs)
3 (20.0%)
37 (97.4%)
Falls Risk
4 (26.7%)
31 (81.6%)
Medication issues
9 (60.0%)
31 (81.6%)
Social Vulnerability
1 (6.7%)
12 (31.6%)
Malnutrition
3 (20.0%)
12 (31.6%)
Depression (PHQ-9)
1 (6.7%)
11 (28.9%)
Conclusion:
In summary, theVES-13 was useful in selecting
patients with more deficits in every CGA domain. However,
many patients with low VES-13 scores still benefitted from
being assessed by the GO clinic. In situations with limited
resources, the VES-13 may help identify patients who would
benefit most from a geriatric oncology assessment.
Disclosure of interest:
None declared
Keywords:
Geriatric syndromes, VES-13, vulnerable older
adults
P128
FEASIBILITY OF INTRODUCING VULNERABILITY SCREENING
IN AN AMBULATORY CANCER CLINIC
R. Jin
1,
*, A. Loucks
1
, M. Puts
2
, P. Savage
1
, T. Stuart-McEwan
1
,
S. Alibhai
1
1
Princess Margaret Cancer Centre,
2
University of Toronto, Toronto,
Canada
Introduction:
The aging of the cancer population and
limited geriatric oncology expertisemean that it is not possible
to have every older cancer patient assessed by specialized
teams. Vulnerable older adults that score 3 or higher on the
Vulnerable Elders Survey (VES-13) have 4 times the risk for
death or functional decline over the next 2 years than those
that score 0-2 (Saliba D, J Am Geriatr Soc, 2001). Incorporating
vulnerability screening to identify those in greatest need in
ambulatory oncology clinics has been advocated, but the
feasibility of widespread implementation in a large cancer
centre has not been explored.
Objectives:
To evaluate the feasibility of establishing a
vulnerability screening process at the Princess Margaret
Cancer Centre, Toronto, Canada to help identify older adults
with cancer who would benefit from a specialized evaluation
in a newly established geriatric oncology (GO) clinic.
Methods:
Based on earlier planning and needs assess-
ments, we began with the genitourinary (GU) oncology site.
In July 2015, the GU nurses and oncologists agreed to have
new patients, 75 years of age and older, complete the VES-
13 independently and return the completed survey to the
nurses to calculate the final score. VES-13 scores
3 indicated
the need for further evaluation and possible referral to
the GO clinic. Over a 9-month period, few VES-13 forms
were completed and no referrals were received based on
abnormal VES-13 criteria. Nurses reported an inability to
conduct vulnerability screening in new older adult patients
due to intensity of existing workload. Using a rapid design
quality improvement perspective, we enlisted the help of
the Information Technology group for a one-month period
(April 25
th
-May 20
th
, 2016) to embed the VES-13 tool into an
already existing patient-friendly electronic interface used
for symptom screening (DART) to create the Geri-DART. We
examined acceptability, completeness, and performance of
the VES-13.
Results:
From April 25
th
-May 20th, 199 GU patients aged 75
or older completed the Geri-DART. 60 patients (30%) had a high
VES-13 score and 11 reported having had 2 or more falls in the
past 12 months. Completeness of the Geri-DART was 97%. The
average Geri-DART completion time compared to pre-VES-13
DART remained identical: the average time was 5.62 mins.
In semi-structured interviews with patients acceptability of
the Geri-DART was excellent. Of the 60 high VES-13 scoring
patients, based on further chart-based screening by GO
nurses, 30 were not eligible for GO clinic referral for reasons
such as palliative status and patient moving. Of the remaining
30 patients, 5 have been booked for assessment, 8 refused,
and the remaining are in progress.
Conclusion:
The Geri-DART appears to be feasible to
implement in the GU site. Thirty percent of patients age 75
or older were vulnerable and half of these were appropriate