What will perioperative geriatric assessment for older cancer patients look like in 2025? Advantages and limitations of new technologies in geriatric assessment

Abstract

For years, surgeons have explored the relationship between age and surgical outcomes. Over time, it is more widely accepted that frailty and fitness of older patients, rather than their age, should be considered in surgical decision making. The gold standard of frailty assessment is comprehensive geriatric assessment (CGA) which is best performed by geriatricians. In the past decade, Digital Health Technologies that range from electronic solutions for electronic Patient-reported Outcomes to wearables and sensors have emerged. As these solutions are likely to expand and advance in the next years, we will review the history of investigating factors, especially aging-related factors associated with surgical outcomes, and the current supportive data about the potential and challenges of Digital Health Technologies in complementing or replacing some of the components of CGA by 2025.

The New Trend, Geriatric Surgery: Considerations in Geriatric Surgery

“…Older age goes hand and hand with FS decline and can be seen in almost every frail patient. There is more and more evidence suggesting that impaired FS status is associated with poor postoperative outcomes [4,9,20] and unfortunately, most anesthesiologists and surgeons do not measure physical needs in the preop phase [4]. It is recommended that patients undergo presurgery screening and assessment of functional mobility and their ability to perform BADLs and IADLs.…”

Surgical Considerations for Older Adults With Cancer: A Multidimensional, Multiphase Pathway to Improve Care

“…Stepwise implementation of six patient-centered moves a technologies may allow improvements in both monitoring and understanding postoperative recovery. 21,22 In addition, attempts at longitudinal assessments up to 1 year after surgery may be useful to determine true recovery. 23 Understanding these outcomes may better support patientcentered perioperative and cancer care.…”

“…26,27 Shared care models, also referred to as a comanagement or team-based care, emphasize collaborative care with shared responsibility between surgical and geriatric teams. 21,28 How preoperative geriatric-specific assessments are included also varies, usually based on resources available. 29 Assessments may include single screening tools or comprehensive geriatric assessment (GA), and the results may simply identify those at increased risk or be used for shared decision making, multidisciplinary tumor board discussions and treatment decisions, filtering for prehabilitation strategies, and informing fully integrated shared care.…”

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery

“…161 Patient-reported outcomes (PROs), despite their complexity, can be captured by integrating smart devices into electronic medical record systems and using a variety of programs to collect data. 162,163 Tools to measure QoL in frail older patients with colorectal cancer may include a variety of European Organisation for Research and Treatment of Cancer (EORTC) QoL questionnaires‚ as the study cohorts used to validate these tools included older patients, and forms are available specifically for older patients (eg, EORTC QLC-CR29, EORTC QLQ-C30, and EORTC QLQLMC). 164 The University of California, Los Angeles 3-Item Loneliness Scale, evaluating how often patients feel they lack companionship or feel left out or isolated from others, was also reported to be useful in assessing PROs in frail individuals.…”