Elsevier

Journal of Geriatric Oncology

Volume 6, Issue 5, September 2015, Pages 353-361
Journal of Geriatric Oncology

Development and psychometric validation of a brief comprehensive health status assessment scale in older patients with hematological malignancies: The GAH Scale

https://doi.org/10.1016/j.jgo.2015.03.003Get rights and content

Abstract

Objectives

The purpose of this study was to develop a new brief, comprehensive geriatric assessment scale for older patients diagnosed with different hematological malignancies, the Geriatric Assessment in Hematology (GAH scale), and to determine its psychometric properties.

Materials and Methods

The 30-item GAH scale was designed through a multi-step process to cover 8 relevant dimensions. This is an observational study conducted in 363 patients aged  65 years, newly diagnosed with different hematological malignancies (myelodysplasic syndrome/acute myeloblastic leukemia, multiple myeloma, or chronic lymphocytic leukemia), and treatment-naïve. The scale psychometric validation process included the analyses of feasibility, floor and ceiling effect, validity and reliability criteria.

Results

Mean time taken to complete the GAH scale was 11.9 ± 4.7 min that improved through a learning-curve effect. Almost 90% of patients completed all items, and no floor or ceiling effects were identified. Criterion validity was supported by reasonable correlations between the GAH scale dimensions and three contrast variables (global health visual analogue scale, ECOG and Karnofsky), except for comorbidities. Factor analysis (supported by the scree plot) revealed nine factors that explained almost 60% of the total variance. Moderate internal consistency reliability was found (Cronbach's α: 0.610), and test–retest was excellent (ICC coefficients, 0.695–0.928).

Conclusion

Our study suggests that the GAH scale is a valid, internally reliable and a consistent tool to assess health status in older patients with different hematological malignancies. Future large studies should confirm whether the GAH scale may be a tool to improve clinical decision-making in older patients with hematological malignancies.

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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