What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

Abstract

Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology. CASE J.K. is a 73-year-old man who presented to his primary care physician complaining of bright red blood per rectum. He has a medical history of coronary artery disease, hypertension, hyperlipidemia, and cerebrovascular disease. He is on aspirin, lisinopril, metoprolol, and atorvastatin. A subsequent colonoscopy revealed a 3-cm mass in his descending colon. Biopsy of the mass showed invasive adenocarcinoma. He underwent computed tomography scans of the chest, abdomen, and pelvis, which showed no evidence of metastases. A laparoscopic colectomy was performed, and his cancer was staged as T2N2 (stage III) and microsatellite stable. He is referred to you to discuss adjuvant chemotherapy.

Do all patients with recurrent ovarian cancer need systemic therapy?

“…15 This may be even more relevant in frail elderly patients with ROC, particularly those with PR-ROC given the low response rates observed even in younger and fitter patients. 15 This may be even more relevant in frail elderly patients with ROC, particularly those with PR-ROC given the low response rates observed even in younger and fitter patients.…”

“…There are several reliable tools available with which to assess elderly patients and a comprehensive geriatric assessment screen for vulnerability should be part of the patient workup to identify this frail and vulnerable subset of patients. 15,16 However, it is worth noting that an expert panel could not endorse one tool over another. 17,18 It is beyond the scope of this article to discuss geriatric assessments, but they all essentially include an assessment of several domains, including physical functioning, psychosocial factors, concurrent medications, comorbidities, nutrition, and cognition.…”

“…The role of systemic therapy should be questioned in frail elderly patients as well as patients with multiple comorbidities diagnosed with ovarian cancer given their poor prognosis and high likelihood of experiencing significant chemotherapy-related toxicity. 15 This may be even more relevant in frail elderly patients with ROC, particularly those with PR-ROC given the low response rates observed even in younger and fitter patients. There are several reliable tools available with which to assess elderly patients and a comprehensive geriatric assessment screen for vulnerability should be part of the patient workup to identify this frail and vulnerable subset of patients.…”

“…There are several validated instruments that have been discussed in detail elsewhere. 15,16 However, it is worth noting that an expert panel could not endorse one tool over another. 19 To the best of my knowledge, there are no reported studies regarding the use of a geriatric assessment specifically in elderly patients with ROC to determine suitability for chemotherapy.…”

Using Information Technology in the Assessment and Monitoring of Geriatric Oncology Patients

“…A comprehensive geriatric assessment (CGA) can be helpful in this setting. [8] CGA is a set of validated tools to assess domains such as physical function, nutritional status, medications, social support, cognitive function, and psychological health [9]. Studies have shown that a CGA provides a more accurate determination of functional age in older patients with cancer compared to chronological age or physician-assigned performance status alone [2].…”