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Diagnostic Accuracy of Self-Reported Tools for Frailty Assessment in Older Adults With Cancer: A Diagnostic
Dwi Apriadi1,2, Saranya Pimolkatekul3, Evi Susanti2
1School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Introduction:
Questionnaires are commonly used for rapid frailty assessment. However, which scale is most appropriate for the identification of frailty in older adults with cancer remains unclear.
Objective:
A diagnostic meta-analysis was conducted to examine the sensitivity and specificity of questionnaire-based assessment tools in detecting frailty among older adults with cancer.
Methods:
Five databases were searched for eligible studies from inception to January 26, 2025. Study quality was evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies tool. The pooled sensitivity and specificity of the frailty assessment tools were assessed through a bivariate random-effects model. Factors influencing the heterogeneity of sensitivity and specificity values were assessed through moderator analysis, which comprised a subgroup analysis and metaregression.
Results:
Five questionnaire-based tools (i.e., the Edmonton Frailty Scale, FRAIL scale, Groningen Frailty Indikator [GFI], Tilburg Frailty Indikator, and Vulnerable Elders Survey-13 [VES-13]) for assessing frailty in older adults with cancer were identified in the literature; the most commonly used were the GFI and VES-13. The sensitivity and specificity of the GFI (67% and 81%, respectively) and VES-13 (65% and 81%) were calculated. Studies with a high proportion of male participants had poorer GFI sensitivity. Older patient samples were associated with lower VES-13 sensitivity, and a high prevalence of frailty or patients having stage III-IV cancer was associated with higher sensitivity.
Conclusion:
The GFI and VES-13 demonstrated high specificity but low sensitivity for frailty assessment in older adults with cancer. Frequent assessment with the GFI or VES-13 is recommended to improve frailty detection.
Implications For Practice:
Health-care professionals, including oncology nurses, care managers, and oncologists, can incorporate the GFI and VES-13 into cancer care settings to improve early frailty detection and management. Pre-Registration: The study protocol was registered at PROSPERO (CRD42024505836).
