G8 geriatric screening tool

What it measures. The G8 was designed in France for oncology clinics as a quick filter. Seven items come from the Mini Nutritional Assessment (food intake, weight loss, mobility, neuropsychological problems, body mass index, number of medicines, self-rated health) plus age, scored out of 17; a score of 14 or less is abnormal and identifies patients likely to have deficits on a comprehensive geriatric assessment. Alternatives include the Vulnerable Elders Survey (VES-13) and the Clinical Frailty Scale.

Evidence and guidelines. The validation study (Annals of Oncology 2012) in 364 older patients starting chemotherapy showed a sensitivity around 85 per cent for an abnormal geriatric assessment, at the cost of low specificity, so most flagged patients will go on to the longer assessment. An abnormal G8 also predicts chemotherapy toxicity, treatment completion and survival on its own. The International Society of Geriatric Oncology recommends screening all patients aged 70 and over with a tool such as the G8, and the 2023 update of the ASCO guideline recommends geriatric assessment for everyone 65 and older receiving systemic therapy, offering a short Practical Geriatric Assessment where resources are limited.

What changes. A normal G8 means the patient can be treated as a fit adult. An abnormal score leads to a full assessment of function, falls, cognition, mood, nutrition, comorbidity and social support, and to the interventions that the GAP70+ and GAIN trials showed reduce severe toxicity: dose adjustment, deprescribing, physiotherapy, dietitian referral and social support. The screen costs nothing but a few minutes of a nurse's time and can be completed in the waiting room; its low specificity is the price of missing few vulnerable patients.