Progress in cancer research is coupled with increased treatment complexity reliant upon accurate patient selection. Oncologists rely upon measurement instruments of functional performance such as the Karnofsky or Eastern Cooperative Oncology Group Performance Status scales that were developed over fifty years ago to determine a patient's suitability for systemic treatment. These standard assessment tools have been shown to correlate with response to chemotherapy, chemotherapy tolerability, survival, and quality of life of cancer patients. However, these scales are subjective, subject to bias and high interobserver variability. Despite these limitations important clinical decisions are based on PS including eligibility for clinical trials, the “optimal” therapeutic approach in routine practice, and the allocation of healthcare resources. This paper reviews the past, present, and potential future of functional performance status assessment in an oncology setting. The potential ability of electronic activity monitoring systems to provide an objective, accurate measurement of patient functional performance is explored. Electronic activity monitoring devices have the potential to offer positive health-related opportunities to patients; however their introduction to the healthcare setting is not without difficulty. The potential role of this technology in healthcare and the challenges that these new innovations pose to the healthcare industry are also examined.

Key Points Question Can a more clinically feasible version of the modified Frailty Index for older patients with cancer be developed? Findings In this cohort study of 1137 older patients with cancer, the Memorial Sloan Kettering–Frailty Index (MSK-FI) was associated with aging-related impairments. A higher score on the MSK-FI was also associated with a longer length of stay, higher odds of intensive care unit admission, and lower overall survival. Meaning The MSK-FI may be a feasible tool to perioperatively assess frailty in older patients with cancer.

Key Points Question Is collaboration between geriatricians and surgeons in the perioperative care of older patients with cancer associated with postoperative outcomes? Findings In this cohort study including 1892 patients aged 75 years and older, the adjusted probability of death within 90 days after surgery was 4.3% for patients who received geriatric comanagement of care, compared with 8.9% for patients who received care management from the surgical service only. Meaning These findings suggest that when feasible, older patients undergoing surgical treatment for cancer should receive geriatric care comanagement as part of their perioperative care.

Objectives: Care for older adults with cancer became more challenging during the COVID-19 pandemic. We sought to examine healthcare providers' clinical barriers, patient questions, and overall experiences related to care delivery for these patients during the pandemic. Materials and methods: Members of the Advocacy Committee of the Cancer and Aging Research Group along with the Association of Community Cancer Centers developed a 20-question survey for healthcare providers of older adults with cancer. Eligible participants were recruited by email sent through professional organizations' listservs, email blasts, and social media. This manuscript reports the qualitative data from the survey's three open-ended questions. Free text, open-ended survey items were analyzed by two independent coders for identification of common themes using NVivo software. Theme agreement was reached through consensus and count comparisons of participant responses were made. Results: Healthcare system organizational challenges and meeting basic needs and support were commonly reported themes among respondents (n = 274). Barriers to care delivery included organizational challenges, patients' access to resources and support, concerns for patients' mental and physical health, and telehealth challenges. Respondents reported older adults were asking about their health and cancer care as well as access to basic needs and supports. Providers described worrying about patients' mental health, fear of personal safety, frustration in multi-level institutions, as well as experiencing positive leadership and communication. Conclusion: Providers are faced with balancing their concerns for personal and patient safety. These findings demand resources and support allocation for older adults with cancer and healthcare providers during the COVID-19 pandemic.

Background The American College of Surgeons and American Geriatrics Society recommend performing a geriatric assessment (GA) in the preoperative evaluation of older patients. To address this, we developed an electronic GA; the Electronic Rapid Fitness Assessment (eRFA). We reviewed the feasibility and clinical utility of the eRFA in the preoperative evaluation of geriatric patients. Methods We performed a retrospective review of our experience using the eRFA in the preoperative assessment of geriatric patients. The rate of and time to completion of the eRFA were recorded. The first 50 patients who completed the assessment were asked additional questions to assess their satisfaction. Descriptive statistics of patient-reported geriatric-related data were used for analysis. Results In 2015, 636 older cancer patients (median age, 80 years) completed the eRFA during preoperative evaluation. The median time to completion was 11 minutes (95% CI, 11 to 12 minutes). Only 13% of patients needed someone else to complete the assessment for them. Of the first 50 patients, 90% (95% CI, 75% to 98%) responded that answering questions by using eRFA was easy. Geriatric syndromes were commonly identified through the performance of the GA: 16% of patients had a positive screening for cognitive impairment, 22% (95% CI, 19% to 26%) needed a cane to ambulate, and 26% (95% CI, 23% to 30%) had fallen at least once during the previous year. Conclusion Implementation of the eRFA was feasible. The eRFA identified relevant geriatric syndromes in the preoperative setting that, if addressed, could lead to improved outcomes.

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Older patients are at increased risk for complications and death following allogeneic hematopoietic cell transplantation (allo-HCT). Traditional transplant-specific prognostic indices such as hematopoietic cell transplant comorbidity index (HCT-CI) may not capture all underlying geriatric vulnerabilities, and in-depth evaluation by a geriatrician prior to transplant may not always be available. We hypothesize that routine pre-transplant interdisciplinary clinical assessment may uncover prognostically important geriatric deficits. Using an institutional database of 457 adults aged 60 years and older who underwent first allo-HCT for hematological malignancies from 2010 to 2017, we examined the prognostic impact of pre-transplant deficits in geriatric domains of function, mobility, mood, medication, nutrition, and relevant biochemical markers. We found that impairment in instrumental activities of daily living (IADL) was

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