Development and psychometric validation of a brief comprehensive health status assessment scale in older patients with hematological malignancies: The GAH Scale
Introduction
Older subjects (aged 65 years or older) encompass the most prevalent population in the oncologic setting.1 A considerably increase is expected in the prevalence of neoplasic diseases in the forthcoming decades, as a result of the increment of life expectancy and the aging of the population.2
Older cancer patients, compared with their younger counterparts, commonly have distinct characteristics (multi-morbidity, geriatric conditions, physical and cognitive impairments, social and care problems, need for help or assistance from a third party, and lower physiologic reserves) that complicate the process of treatment decision-making, leaving part of this group of patients under-treated.[3], [4], [5]
The US National Comprehensive Cancer Network and the International Society of Geriatric Oncology[6], [7] have recommended that some form of geriatric assessment in the oncology setting are needed to discriminate between older patients who are fit enough for intensive therapy and those who are frail.[8], [9] However, most of the available instruments for comprehensive geriatric assessment (CGA) in cancer patients are complex and time-consuming, which may hinder its regular use in daily practice as a tool for proper clinical decision.10
Despite the fact that several screening tools have been developed for geriatric assessment in the oncology setting,[11], [12], [13], [14] there is still a need for a short health status assessment scale to identify opportunities for effective interventions in the geriatric population with hematologic diseases.
Current research to improve outcomes in cancer older patients keeps working on the development of new geriatric screening tools. In fact, the recently published validation process of the G8 screening tool in older patients with aggressive hematological malignancies was shown to be valid to identify frail patients that would benefit from a comprehensive assessment, although their comorbidities were not considered.15 Additionally, the systematic review conducted by Hamaker et al.16 demonstrated that a geriatric assessment in elderly patients with a hematological malignancy can detect health issues, even in patients showing a good performance status.
In this context, we aimed to develop and validate the psychometric properties of a new and brief CGA scale of Geriatric Assessment in Hematology (the GAH scale) and to determine its psychometric properties in patients diagnosed with different hematological malignancies.
Section snippets
Material and Methods
The GAH scale was designed by a group of hematologists and geriatricians as a thorough evaluation for older subjects with different hematological malignancies, encompassing 30 items grouped into eight pre-defined dimensions from individually validated and standardized clinical tools (Appendix 1).
The development of the GAH scale was conducted through a multi-step process that included: inter-pool generation, stake-holder consultation and content validation. The design of the scale was focused to
Study Participants
Between May 2012 and January 2014, a total of 363 subjects were enrolled in the project. Fourteen were excluded due to not meeting the selection criteria (13 patients) and withdrawal of informed consent (1 patient). Thus, 349 patients were finally evaluable for final analyses. As per protocol, diagnoses were equally distributed: MDS or AML (33.2%), MM (33.8%), and CLL (33.0%). Patients' demographic and clinical characteristics are presented in Table 2.
Feasibility
The mean time taken to complete the GAH
Discussion
The present study describes the methodological approach to the development and validation of the psychometric properties of “the GAH scale”, a new CGA scale for older adults diagnosed with different hematological malignancies (MDS, AML, MM, and CLL). Our study results demonstrate that the GAH scale is psychometrically valid, internally reliable and a consistent tool to assess health status in older patients with hematological malignancies.
Our study clearly shows that the GAH scale is an easy
Disclosures and Conflict of Interest Statements
Silvia López is a Medical Affairs Project Manager of Celgene S.L.U. Marta Durán and Marina Marcos are Regional Medical Liaisons of Celgene S.L.U.
Silvia López, Marta Durán and Marina Marcos declare that they have stock ownership from Celgene S.L.U.
Silvia López, Marta Durán, Marina Marcos, Meritxell Nomdedeu and Antonio Garcia have received honoraria from Celgene S.L.U.
Silvia López, Marta Durán and Alfonso Cruz-Jentoft have received research funding from Celgene S.L.U.
Author Contributions
Study concept: S Bonanad, J De la Rubia, AJ Cruz-Jentoft
Study design: S Bonanad, J De la Rubia, AJ Cruz-Jentoft
Data acquisition: S Bonanad, J De la Rubia, M Gironella, E Pérez-Persona, B González, C Fernández-Lago, M Arnan, M Zudaire, JA Hernández-Rivas, A Soler, C Marrero, C Olivier, A Altés, D Valcárcel, MT Hernández, I Oiartzabal, R Fernández-Ordoño, M Arnao, A Esquerra, J Sarrá, E González, J González, X Calvo, M Nomdedeu, A García, A Ramírez-Payer
Quality control of data and algorithms: A
Acknowledgments
The authors would like to acknowledge the remaining investigators of the GAH Group for its valuable contribution in the study: Pau Abrisqueta, Olga Salamero, Any Jaramillo and Oriol Olivé (H.U. Vall d'Hebron, Barcelona, Spain), Beatriz Soria, Sandra Iraheta, Sunil Lakhwani, Gloria González, Ma José Rodríguez, Cornelia Stoica and Marta Fernández (H.U. de Canarias, Tenerife, Spain), Josune Gorrotxategui and Ma Victoria Madinabeitia (H.U. de Araba—Txagorritxu, Vitoria-Gasteiz, Spain), Isidro
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