EURURO Vol. 72 No. 4

524 656

recommendations are to estimate life expectancy based on
the combination of age and comorbidity . Therefore,
the choice remains pragmatic and open to debate. However
for future research better tools are desirable. It is vital that
decision-making is shared with patients and that they
receive detailed information, including assessment of
potential risks and benefits
Health status in SIOG guidelines has generally been
defined according to groups described by Balducci and
Extermann in 2000 These revised prostate cancer
guidelines classify patients into four groups (the terminol-
ogy now aligns with that in the geriatric literature) along
with the implications for treatment .
(1) Healthy or fit: G8 score >14. Patients are expected to
tolerate any form of standard treatment. The choice of a
particular local treatment is then based on the patient’s
wishes and the risk of specific side effects, such as
incontinence (described below), for each modality.
(2) Frail: patients with a G8 score 14 but whose problems,
as established via a simplified geriatric assessment
(CIRS-G, ADL, and malnutrition), are considered revers-
ible. Such problems are: one or two reversible
deficiencies in ADL (apart from incontinence); CISR-G
grade 2 comorbidities (a single grade 3 comorbidity
may also be reversible); and weight loss of 5–10%.
Patients whose problems are reversed can be consid-
ered fit for standard prostate cancer therapies.
(3) Disabled or with severe comorbidities: nonreversible
problems. These include more than two ADL deficien-
cies; multiple grade 3 comorbidities on the CISR-G or
any grade 4 comorbidity; or weight loss >10%. Such
patients should be managed symptomatically. Certain
patients may benefit from geriatric interventions
indicated after CGA and can be given specific adapted
cancer treatments.
(4) Terminally ill: palliation only.
Two additional points should be made. First, in patients
who require a CGA, specific geriatric interventions may be
suggested. Second, if the mini-COG[4_TD$DIFF]
TM score is abnormal, a
full neuropsychological assessment is recommended.
Table 2 – The Mini-COG[4_TD$DIFF]
TM screening tool[6_TD$DIFF]. Copyright S. Borson, reprinted with permission of the author ).
Step 1: Three words registration
Look directly at person and say, ‘‘Please listen carefully. I am going to say three words that I want you to repeat back to me now and try to remember. The words
are [select a list of words from the versions below]. Please say them for me now.’’ If the person is unable to repeat the words after three attempts, move on to
Step 2 (clock drawing).
The following and other word lists have been used in one or more clinical studies. For repeated administrations, use of an alternative word list is recommended.
Version 1 Version 2 Version 3 Version 4 Version 5 Version 6
Banana Leader Village River Captain Daughter
Sunrise Season Kitchen Nation Garden Heaven
Chair Table Baby Finger Picture Mountain
Step 2: Clock drawing
Say: ‘‘Next, I want you to draw a clock for me. First, put in all of the numbers where they go.’’ When that is completed, say: ‘‘Now, set the hands to 10 past 11.’’
Use a preprinted circle for this exercise. Repeat the instructions as needed, as this is not a memory test. Move to Step 3 if the clock is not complete within 3 min.
Step 3: Three words recall
Ask the person to recall the three words you stated in Step 1. Say: ‘‘What were the three words I asked you to remember?’’ Record the word list version
number and the person’s answers.
Scoring
Word recall: ______ (0–3 points)
=1 point for each word spontaneously recalled without cueing.
Clock draw: ______ (0 or 2 points)
=Normal clock: 2 points. A normal clock has all numbers placed in the correct sequence and approximately correct position (eg, 12, 3, 6, and 9 are in anchor
positions) with no missing or duplicate numbers. Hands are pointing to the 11 and 2 (11:10). Hand length is not scored.
Inability or refusal to draw a clock (abnormal) = 0 points.
Total score: ______ (0–5 points)
=Total score: word recall score + clock draw score.
A cut point of <3 on the Mini-COG[4_TD$DIFF]
TM has been validated for dementia screening, but many individuals with clinically meaningful cognitive impairment will
score higher. When greater sensitivity is desired, a cut point of <4 is recommended as it may indicate a need for further evaluation of cognitive status.
Table 3 – Summary of the different steps in health status evaluation and estimated time required
Step Tools Time Who can do it?
Mandatory initial step G8
Mini-COG[7_TD$DIFF]
TM
5 min
5 min
Trained nurse
Trained nurse
Simplified geriatric evaluation if G8 score is 14 ADL
CIRS-G
Weight loss
1 min
15 min
1 min
Trained nurse
Trained nurse and/or doctor
Trained nurse
Comprehensive geriatric assessment if geriatric
intervention needed
Screening tools and complete
clinical examination
2 h to 1 d in hospital Geriatrician + other health professionals
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 5 2 1 – 5 3 1 524