Estimating the risk of chemotherapy toxicity in older patients with cancer : the role of the Vulnerable Elders Survey-13 (VES-13)

Objective: Some parameters of the Comprehensive Geriatric Assessment (CGA) are predictive of chemotherapy toxicity. The Vulnerable Elders Survey-13 (VES-13) is a short instrument that has been tested as a means of identifying patients who need a full CGA, but its ability to predict chemotherapy toxicity is still unclear. We performed a pooled analysis of four published clinical trials studying VES-13 as a means of diagnosing vulnerability, in order to evaluate its accuracy in predicting the risk of grade 3/4 toxicity in older patients undergoing chemotherapy. Materials and Methods: The study involved patients aged ≥ 66. years with a diagnosis of solid or hematological cancer, all of whom were administered VES-13. The number of medications taken by each patient, their comorbidities, their Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score and index, the type of chemotherapy and treatment line, and their Mini Mental State Evaluation (MMSE), and Mini Nutritional Assessment (MNA) scores were recorded. Information was available concerning the grades 3-4 hematological and non-hematological toxicities experienced by each patient. Results: The study involved 648 patients aged ≥ 66 years (mean age 76.2 ±4.5, range 66-90) of whom 336 (51.9%) were female. VES-13 identified 287 patients (44.3%) as vulnerable. Grades 3-4 hematological and non-hematological toxicities were more prevalent in the vulnerable subjects (35.2% vs 20.8%, p < 0.0001, and 18.5% vs 10.8%, p = 0.0055), who were also at higher risk of both (adjusted ORs 2.15, 95% CI 1.46-3.17, p < 0.001); and 1.66 (95% CI 1.02-2.72, p = 0.043). Conclusions: VES-13 could be considered to be a good candidate for future prospective studies to assess older patients with cancer at risk of toxicity.