What is the Geriatric 8 (G8)?
The Geriatric 8 (G8) is a rapid, evidence-based questionnaire designed for healthcare professionals to screen for frailty and potential vulnerabilities in older adults with cancer. Developed to address the specific needs of geriatric oncology, the tool is a vital first step in a patient's care pathway. It helps identify those who require a comprehensive geriatric assessment (CGA), a more detailed evaluation of their health, functional status, and psychosocial needs. The G8 is particularly valuable because it acknowledges that chronological age is not the sole determinant of an individual's health and ability to tolerate cancer treatment.
The Eight Domains of the G8 Screening Tool
The G8 questionnaire evaluates eight key domains to provide a quick, holistic snapshot of a patient's health. The eight items are comprised of a single age-related question and seven questions adapted from the Mini-Nutritional Assessment (MNA) tool. Each domain is scored, contributing to a final sum that guides clinical decision-making. The domains are as follows:
- Age: The patient's chronological age is a contributing factor, but it is one piece of a larger picture.
- Nutritional Intake: Changes in food consumption over the past three months are evaluated.
- Weight Loss: Unintentional weight loss within the last three months is a significant indicator of decline.
- Body Mass Index (BMI): A BMI score is assessed to screen for malnutrition risk.
- Mobility: The patient's ability to move and walk is assessed as a proxy for physical function.
- Psychological Status: Questions probe for depression and cognitive issues.
- Medications: The number of medications taken daily, a proxy for polypharmacy, is considered.
- Self-Rated Health: Patients rate their own health, providing a subjective but powerful indicator of their overall well-being.
Interpreting the G8 Score
The total G8 score can range from 0 to 17, with higher scores indicating a healthier status. A standard cut-off score of 14 or less is used to signal potential vulnerability and the need for a follow-up CGA. A score above 14 suggests the patient is less likely to have significant frailty and may not need a full CGA. The use of this simple scoring system allows for a swift and standardized approach to screening, ensuring that at-risk patients do not fall through the cracks of a busy healthcare system.
G8 vs. Comprehensive Geriatric Assessment (CGA)
It is important to distinguish the G8 screening tool from the more detailed Comprehensive Geriatric Assessment (CGA). While the G8 is a brief initial screen, the CGA is a multidisciplinary, in-depth evaluation. The table below outlines the key differences between these two crucial tools in geriatric oncology.
| Feature | Geriatric 8 (G8) | Comprehensive Geriatric Assessment (CGA) |
|---|---|---|
| Purpose | Rapid screening for vulnerabilities in older adults with cancer. | In-depth evaluation of medical, psychosocial, and functional status. |
| Domains Assessed | 8 specific domains, combining age and MNA items. | Broader assessment covering multiple domains like functional status, cognition, mood, social support, nutrition, and comorbidities. |
| Time to Complete | Typically less than 10 minutes. | Longer, more detailed process. |
| Personnel | Often administered by a nurse, physician, or self-reported. | Conducted by a multidisciplinary team of healthcare professionals. |
| Outcome | Identifies patients who need further assessment. | Develops a personalized care and intervention plan. |
The Role of G8 in Improving Cancer Care
The G8 serves as an essential gatekeeper, helping busy oncology teams efficiently allocate resources and attention to the patients who need it most. Without a tool like the G8, it would be impractical to perform a full CGA on every older patient. By identifying vulnerable patients early, clinicians can make more informed decisions about treatment, reduce the risk of toxicities, and improve overall quality of life and survival outcomes.
The Evolution of the G8
The original G8 tool requires a healthcare professional to administer it, which can limit its practical use in certain settings. In response, researchers have developed modernized versions to enhance accessibility and usability. These adaptations include the Self-Geriatric 8 (S-G8) and electronic versions integrated into electronic health records like Epic MyChart. These self-reported versions aim to reduce the time burden on clinical staff while empowering patients to take a more active role in their care. While validation studies show promise for these adaptations, especially in alignment with the original G8, continued testing is necessary to confirm their performance across diverse populations.
The Clinical Pathway using G8 Screening
The clinical process for incorporating the G8 into geriatric cancer care typically follows these steps:
- Initial Screening: An older adult (typically 65+ with a cancer diagnosis) is administered the G8 screening questionnaire, either by a healthcare provider or as a self-reported tool.
- Score Review: The patient's G8 score is calculated. If the score is 14 or less, they are considered vulnerable or at-risk.
- Comprehensive Assessment: Patients with an at-risk G8 score are referred for a comprehensive geriatric assessment (CGA) by a multidisciplinary team.
- Intervention: Based on the CGA results, the team develops and implements targeted interventions tailored to the patient's specific needs, such as nutritional counseling, physical therapy, or psychological support.
- Ongoing Monitoring: The patient's health and treatment response are continually monitored to adjust care as needed.
For more detailed information on integrating geriatric assessments, you can visit the International Society of Geriatric Oncology (SIOG).
Conclusion
The question of what is Geriatric 8 reveals a cornerstone of modern, personalized care for older cancer patients. The G8 screening tool is a fast and effective method for identifying those at risk of treatment complications and poor outcomes. By acting as a trigger for a more in-depth comprehensive geriatric assessment, the G8 ensures that clinicians can address the multifaceted health needs of their older patients, ultimately leading to better-tailored treatments, improved quality of life, and enhanced survival. Its continued evolution through self-administered and electronic versions points toward a more accessible and patient-centered future for geriatric cancer care.
