Appendix 1. CGA-GOLD Screening Questionnaire

Appendix 1. CGA-GOLD screening questionnaire

South-East London Cancer Network / Department of Ageing and Health Guy's and St Thomas' NHS Foundation Trust NAME DOB

In the previous 12 months have you been admitted to a hospital?

Not at all

1 -2 times

3 or more times

Don't know

Do you have diabetes?

I do not have diabetes

My diabetes control is usually good (blood sugars below 10)

My diabetes is usually fair (blood sugars 10 or above)

Don't know

Is your blood pressure generally high when the doctor or nurse checks it?

Don't know

Do you suffer from angina or have you ever had a heart attack?

Don't know

Have you ever had a stroke? No

Don't know

Do you have chronic lung problems?

Don't know

Do you get short of breath walking on flat surfaces?

Don't know

Have you had 1 or more falls from standing or sitting over the past 6 months?

Don't know

Do you have significant memory problems?

Don't know

Have you ever had episodes of feeling confused?

Don't know Do you have poor vision that limits what you can do?

Don't know

Over the past month have you needed more help than usual to take care of yourself?

Don't know

Do you have difficulty with any of the following?

Not A little Quite a bit A lot

at all

Bathing yourself

Climbing stairs

Getting to the toilet

Moving from bed to chair or standing up

Dressing yourself

Walking

Driving

Taking public transport

Shopping for food

Managing financial affairs

Is there a friend, relative or neighbour who would take care of you for a few days if necessary?

Don't know Is there a friend or relative you feel you can talk to about your cancer and cancer treatment?

Don't know

What is your living situation?

Live alone

Live with partner

Live with someone other than partner

Live in sheltered housing

Are you a caregiver for someone who depends on you?

Yes Who? ______

In the past year have you had urinary leakage that has bothered you?

Don't know

Have you lost weight or been eating less in last 6 months?

Don't know Please list the names of ALL the medications that you are taking

Don't know

Do you think you are having any symptoms due to your medications? No

Don't know

Are there any other problems that you would like to tell us about?

THANK YOU This information will help keep track of how you feel and how well you are able to do your usual activities.

1. Have you had any treatment for your cancer this month? Yes No If yes, what kind of treatment did you have? (Please tick all that apply) Chemotherapy Radiotherapy Surgery Other (please specify)

2. What kind of formal practical support did you get this month? (This is support provided to you by an agency, a service or a paid carer) Transport to the Help shopping Help around the Financial hospital house support or advice Handyperson/ Gardening Emotional support Exercise group DIY

Other (please specify) 1. Please rate overall the formal support you have received. Excellent Very Good Fair Poor Good Please tick the one box that best describes your answer Any other comments? (Was there any support or person that was particularly helpful or unhelpful?)

3. What kind of support did you get this month from friends, family, neighbors etc? Transport to the Help shopping Help around the Financial hospital house support or advice Handyman/DIY Gardening Emotional support Exercise group

Other (please specify)

4. Is there any practical support that you would have found helpful that you did not receive? Yes No

Thank you

[2] EORTC QLQ C30 (V3) - Validated quality of life questionnaire –

We are interested in some things about you and your health. Please answer all of the questions yourself by circling the number that best applies to you. There are no “right” or “wrong” answers. Not at A Quite Very

all little a bit much

1. Do you have any trouble doing strenuous activities 1 2 3 4 like carrying a heavy shopping bag or a suitcase

2. Do you have any trouble taking a long walk? 1 2 3 4

3. Do you have any trouble taking a short walk outside of the house? 1 2 3 4

4. Do you need to stay in bed or a chair during the day? 1 2 3 4

5. Do you need help with eating, dressing, washing yourself or using the toilet? 1 2 3 4

During the past week:

6. Were you limited in doing either your work or other daily activities? 1 2 3 4

7. Were you limited in pursuing your hobbies or other leisure time activities? 1 2 3 4

8. Were you short of breath? 1 2 3 4

9. Have you had pain? 1 2 3 4

10. Did you need to rest? 1 2 3 4

11. Have you had trouble sleeping? 1 2 3 4

12. Have you felt weak? 1 2 3 4

13. Have you lacked appetite? 1 2 3 4

14. Have you felt nauseated? 1 2 3 4

15. Have you vomited? 1 2 3 4

16. Have you been constipated? 1 2 3 4

17. Have you had diarrhoea? 1 2 3 4

18. Were you tired? 1 2 3 4

19. Did pain interfere with your daily activities 1 2 3 4

20. Have you had difficulty in concentrating on things, like reading a newspaper or watching television? 1 2 3 4

21. Did you feel tense? 1 2 3 4

During the past week:

22. Did you worry? 1 2 3 4 23. Did you feel irritable? 1 2 3 4

24. Did you feel depressed? 1 2 3 4

25. Have you had difficulty remembering things? 1 2 3 4

26. Has your physical condition or medical treatment interfered with your family life? 1 2 3 4

27. Has your physical condition or medical treatment interfered with your social activities? 1 2 3 4

28. Has your physical condition or medical treatment caused you financial difficulties? 1 2 3 4

For the following questions please circle the number between 1 and 7 that best applies to you

29. How would you rate your overall health during the past week? 1 2 3 4 5 6 Very poor Excellent

30. How would you rate your overall quality of life during the past week? 1 2 3 4 5 6 Very poor Excellent

Did you need someone to assist you in completing this questionnaire? No

About how long did it take you to complete the questionnaire? ______minutes Don't know

THANK YOU Appendix 2 CGA and comorbidity variable definitions

CGA variable Dichotomised Source Definition measures 1 Cognition Cognitive impairment/ Self-reported questionnaire Question “Do you have memory problems?” no impairment Cognitive impairment = Responded "yes" No impairment = Responded "no" Missing data = Responded "don't know" or no response entered 2 Delirium Delirium history/ Self-reported questionnaire Question “Have you ever had episodes of feeling confused?” no delirium history Delirium history = Responded "yes" No delirium = Responded "no" Missing data = Responded "don't know" or no response entered 3 Depression Depression/ Self-reported questionnaire - Question “during the past week, did you feel depressed?” no depression EORTC QLQ-C30 section Depression: patient responding “quite a bit” or “very much” No depression: patient responding “no difficulty” or “a little difficulty” Missing data = No response entered 4 Falls Falls/ no falls Self-reported questionnaire Question “have you had 1 or more falls from standing or sitting over the past 6 months?” Falls = Responded "yes" No falls = Responded "no" Missing data = Responded "don't know" or no response entered 5 Visual impairment Visual impairment/ Self-reported questionnaire Question “Do you have poor vision that limits what you can do?” No visual impairment Visual impairment = Responded "yes" No visual impairment = Responded "no" Missing data = Responded "don't know" or no response entered 6 Hearing impairment Hearing impairment/ Electronic clinical notes Hearing impairment= history noted in the clinical records no hearing impairment No hearing impairment= no history noted Missing data: presence/absence of any comorbidities not documented in the clinical notes 7 Osteoporosis/ Osteoporosis/ Electronic clinical notes Osteoporosis/fragility fracture: history noted in clinical notes fragility fractures no osteoporosis No osteoporosis: no history noted Missing data: presence/absence of comorbidities not documented in the clinical notes 8 Urinary incontinence Urinary incontinence/ Self-reported questionnaire Question “in the past year have you had urinary leakage that has bothered you?” no incontinence Urinary incontinence = Responded "yes" No incontinence = Responded "no" Missing data = Responded "don't know" or no response entered 9 Bowels Bowel difficulties/ Self-reported questionnaire - 2 questions " have you been constipated?", and "have you had diarrhoea?" If only one answered, the no bowel difficulties EORTC QLQ-C30 section response of the single question used to define difficulty Bowel difficulties: responding as “quite a bit” or “a lot” to either question No bowel difficulties: responding “no difficulty” or “a little difficulty” to both questions Missing data = No response entered to either questions 10 Nutrition: weight loss Nutritional difficulties/ Self-reported questionnaire Question “have you lost weight or been eating less in the last 6 months? no difficulties Difficulty with nutrition = Responded "yes" No difficulty = Responded "no" Missing data = Responded "don't know" or no response entered 11 ADL dependency Dependent/ independent Self-reported questionnaire 6 ADL questions :"Do you have difficulty with the following - bathing, stairs, toileting, transfers, dressing and walking?" If not all 6 questions completed, the response of those completed used to define difficulty. ADL dependent: reporting "quite a bit" or "very much" in ≥1 ADL question ADL independent: reporting "a little" or "no difficulty" to all questions answered Missing data: No response entered to all 6 questions 12 iADL dependency Dependent/ independent Self-reported questionnaire 4 iADL questions: "Do you have difficulty with the following - shopping, driving, finances, public transport?" If not all 4 questions completed, the response of those completed are used to define difficulty iADL dependent: reporting "quite a bit" or "very much" in ≥1 iADL questions iADL independent: reporting "a little" or "no difficulty" to all questions answered Missing data: No response entered to all 4 questions 13 Poor mobility Poor mobility/ Self-reported questionnaire - Question "do you have trouble taking a short walk outside the house?" no difficulties with EORTC QLQ-C30 section Poor mobility: responding as “quite a bit” or “very much” mobility No difficulties: responding “no difficulty” or “a little difficulty” Missing data = No response entered 14 Exercise Difficulties with exercise/ Self-reported questionnaire - Question "do you have trouble taking a long walk outside the house?" no difficulty with EORTC QLQ-C30 section Difficulty with exercise: responding as “quite a bit” or “very much” exercise No difficulty: responding “no difficulty” or “a little difficulty” Missing data = No response entered 15 Caring arrangements - Lives alone/ otherwise Self-reported questionnaire Question "what is your living situation?" living circumstances Lives alone: answers "lives alone" Otherwise: all other responses (with partner, with someone else, in sheltered housing) Missing data: no response entered 16 Family life Difficulties with family Self-reported questionnaire - Questions “has your physical condition or medical treatment interfered with your family life?” life/ no difficulties with EORTC QLQ-C30 section Difficulty with family life: responding “quite a bit” or “very much” family life No difficulty: responding “no difficulty” or “a little difficulty” Missing data: no response entered 17 Social activities Difficulties with social Self-reported questionnaire - Question "has your physical condition or medical treatment interfered with your social activities?” activities/ no difficulties EORTC QLQ-C30 section Difficulty with social activities: responding as “quite a bit” or “very much” with social activities No difficulty: responding “no difficulty” or “a little difficulty” Missing data: no response entered 18 Social support - care Care available/ Self-reported questionnaire Question "is there a friend, relative or neighbour who would take care of you for a few days if availability no care available necessary?" Care available = Responded "yes" No care available = Responded "no" Missing data = Responded "don't know" or no response entered 19 Social support - Emotional support Self-reported questionnaire Question "is there a friend or relative you feel you can talk to about your cancer and cancer treatment?" emotional available/ no emotional Emotional support available = Responded "yes" No support available = Responded "no" support available Missing data = Responded "don't know" or no response entered 20 Pain limiting activities Limiting pain/ Self-reported questionnaire - Question "do you have pain which interferes with your daily activities?" non-limiting pain EORTC QLQ-C30 section Limiting pain: responding as “quite a bit” or “very much” Non-limiting: responding “no difficulty” or “a little difficulty” Missing data: no response entered 21 Sleep Sleep difficulty/ Self-reported questionnaire - Question "have you had trouble sleeping?" no difficulty sleeping EORTC QLQ-C30 section Sleep difficulty: responding as “quite a bit” or “very much” No difficulty: responding “no difficulty” or “a little difficulty” Missing data: no response entered 22 Polypharmacy Polypharmacy/ Electronic clinical notes Polypharmacy: ≥5 non-chemotherapy drugs noted in the clinical notes no polypharmacy No polypharmacy: <5 non-chemotherapy drugs noted in the clinical notes Missing data: Medication history not documented in the medical notes 23 Hospital admissions 1+ admissions/ Self-reported Question "in the previous 12 months, have you been admitted to hospital?" No admissions Questionnaire 1+ admission: responded "1-2 times" or "3 or more times" No admissions: responded "no" Missing data: no response or responded "don't know" COMORBIDITIES Cardiac disease Cardiac disease/ Electronic clinical notes Cardiac disease: documented history of any cardiac disease including ischaemic heart disease, heart no cardiac disease failure, arrhythmias, valve disease, cardiomyopathy No cardiac disease: no disease noted Missing data: presence or absence of any comorbidities not documented in clinical notes IHD IHD/no IHD Electronic clinical notes IHD: documented history of IHD including angina, MI or CABG No IHD: no history documented Missing data: presence or absence of any comorbidities not documented in clinical notes Arrhythmia Arrhythmia/no arrhythmia Electronic clinical notes Arrhythmia: documented history including brady/tachy arrhythmia history or pacemaker presence documented in the clinical notes No arrthythmia: no documented history Missing data: presence or absence of any comorbidities not documented in clinical notes High cholesterol Hypercholesteraemia/ Electronic clinical notes Hypercholesteraemia: documented history no hypercholesteraemia No hypercholesteraemia: no documented history Missing data: presence or absence of any comorbidities not documented in clinical notes Hypertension Hypertension/no hypertension Electronic clinical notes Hypertension: documented history of hypertension. No hypertension: no documented history Missing data: presence or absence of any comorbidities not documented in clinical notes Vascular Vascular disease/ Electronic clinical notes Vascular disease: documented history including aneurysms, peripheral vascular disease and carotid disease no vascular disease stenosis No vascular disease: no documented history Missing data: presence or absence of any comorbidities not documented in clinical notes Stroke Stroke/no stroke Electronic clinical notes Stroke: documented history of stroke or TIA prior No stroke: no history documented Missing data: presence or absence of any comorbidities not documented in clinical notes Non-stroke Neurological non-stroke Electronic clinical notes Non stroke neurological disease: documented history including peripheral neuropathy, all chronic neurological disease/neurological stroke neurological conditions such as Parkinson's disease, benign essential tremor. Do not include: headaches condition disease with no known neurological diagnosis No non-stroke neurological disease: no history documented Missing data: presence or absence of any comorbidities not documented in clinical notes Diabetes Diabetes/no diabetes Electronic clinical notes Diabetes: documented history of diabetes No diabetes: No history of diabetes documented. Missing data: presence or absence of any comorbidities not documented in clinical notes Respiratory Respiratory disease/none Electronic clinical notes Respiratory disease: documented history including COPD, asthma, fibrosis and any other lung disease disease No respiratory disease: No history of respiratory disease documented. Missing data: presence or absence of any comorbidities not documented in clinical notes CKD CKD/no CKD Electronic clinical notes CKD: documented history of a chronic kidney disease. Not based on review of blood tests. No CKD: no documented history Missing data: presence or absence of any comorbidities not documented in clinical notes GI disease GI disease/no GI disease Electronic clinical notes GI disease: documented history including GORD, hiatus hernia, peptic ulcer disease, inflammatory bowel disease, constipation No GI disease: no documented history Missing data: presence or absence of any comorbidities not documented in clinical notes MSK disease MSK disease/no MSK disease Electronic clinical notes MSK disease : documented history including osteoarthritis, spinal disorders, disc or joint disease, gout/psuedogout No MSK disease: not noted Missing data: presence or absence of any comorbidities not documented in clinical notes Psych disease Psych disease/no disease Electronic clinical notes Psych disease: documented history including depression, psychosis, anxiety and any other psych disorder. No psych: no documented history of psych disorder Missing data: presence or absence of any comorbidities not documented in clinical notes