How to Implement a Geriatric Assessment in Your Clinical Practice

Sattar, Schroder; Alibhai, Shabbir M.H.; Wildiers, Hans; Puts, Martine

doi:10.1634/theoncologist.2014-0180

Cited by 63 publications

(42 citation statements)

References 158 publications

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“…The median time to complete the eRFA for preoperative assessment was an acceptable 11 minutes, which is similar to the time it takes to complete a screening assessment (rather than a complete GA) 18 and is much shorter than the time reported to complete a paper-version GA (30 minutes). 19 In addition, the majority of patients were able to complete the eRFA on their own or with assistance from a caregiver.…”

Section: Discussionmentioning

confidence: 76%

Electronic Rapid Fitness Assessment: A Novel Tool for Preoperative Evaluation of the Geriatric Oncology Patient

Shahrokni¹,

Tin²,

Downey³

et al. 2017

J Natl Compr Canc Netw

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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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Section: Discussionmentioning

confidence: 76%

Electronic Rapid Fitness Assessment: A Novel Tool for Preoperative Evaluation of the Geriatric Oncology Patient

Shahrokni¹,

Tin²,

Downey³

et al. 2017

J Natl Compr Canc Netw

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“…13 To contend with this problem, brief screening instruments and geriatric assessments to detect major geriatric-associated problems are used more and more to formally evaluate older patients with cancer, 14 and there is a call to perform at least a screening before treatment initiation. An extensive body of data has shown that geriatric assessment can identify major issues not usually found by oncologists, many with proven beneficial interventions (eg, falls).…”

Section: Geriatric Assessment and Estimating Life Expectancymentioning

confidence: 99%

“…15 The use of performance status as a global estimation of function for older patients is inadequate. 14 An estimation of life expectancy should be done for all older patients before making a treatment plan. 16 We prefer the Cancer and Aging Research Group (www.mycarg.org) tool 17 for performing a brief geriatric assessment because its use is feasible in the clinical trial and community settings 18 and because it can be used to predict chemotherapy-related toxicity.…”

Section: Geriatric Assessment and Estimating Life Expectancymentioning

confidence: 99%

Breast Cancer in Women Older Than 80 Years

Shachar

Hurria

Muss

2016

JOP

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Breast cancer is the most common cancer in women, with an incidence that rises dramatically with age. The average age at diagnosis of breast cancer is 61 years, and the majority of woman who die of breast cancer are age 65 years and older. Major improvements in public health and medical care have resulted in dramatic increases in longevity. The oldest old (those age 80 years and older) are a rapidly expanding group and now comprise 9 million members of the US population. The treatment of individuals who are age 80 years and older is complex and involves clearly defining the goals and value of treatment while also weighing risks, such as the potential effects of treatment on functional loss and quality of life. Limited evidence-based treatment guidelines exist for the caring of this older cohort of patients with breast cancer. Data from clinical trials that enroll primarily younger patients lack the information needed to estimate the likelihood of toxicities that can be life changing in older adults. Clinicians who make treatment recommendations should place the available evidence in the context of the patient's life expectancy and geriatric assessment results that include an evaluation of a patient's functional status, comorbidities, cognition, social support, nutritional status, and psychological state. Furthermore, these decisions should be placed in the context of the patient's goals for treatment, preferences, and values. This review summarizes the current literature and focuses on the role of geriatric assessment in treatment recommendations for patients age 80 years and older with early and metastatic breast cancer.

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“…Though moderate and advanced dementia patients are less often evaluated by oncologists, patients with incipient deficits are not infrequent in daily practice [33]. Different studies based on epidemiological databases show large differences in treatment patterns between cognitively impaired (or dementia) and non-cognitively impaired patients, with the former receiving all treatment modalities less often [34,35].…”

Section: Cognitive Impairment and Social Issuesmentioning

confidence: 99%

“…No specific instruments exists for adjuvant chemotherapy but it is reasonable to use any of the tools evaluated on the international society of geriatric oncology (SIOG) consensus and in the systematic review by Puts et al [54] [62]. CGA evaluates the following core domains: functional status, cognition/depression, comorbidity (a prognostic factor for elderly women with breast cancer [63]), falls, social support, nutrition and polypharmacy [33]. It is important to note that classic oncologic tools such as ECOG performance status and Karnovsky score are not a part of CGA and underperform in the elderly [60,64].…”

Section: Comprehensive Geriatric Assessmentmentioning

confidence: 99%

Adjuvant chemotherapy in elderly patients with breast cancer: key challenges

Pondé

Lago

Azim

2016

Expert Review of Anticancer Therapy

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Elderly women with early breast cancer (BC) form a heterogeneous and large subgroup (41.8% of women with BC are over 65). Decision making in this subgroup is made more difficult by lack of familiarity with their physical, cognitive and social issues. Adequate management depends on biological factors and accurate clinical evaluation through comprehensive geriatric assessment (CGA). CGA can help to better select and determine potential risks factors for patients who are candidates for adjuvant chemotherapy. It is still recently introduced in geriatric oncology and there is a lack of awareness of its importance. Available data on adjuvant chemotherapy for BC is limited but suggests it can be of benefit for well selected patients, though the risk of short and long-term toxicity is significant. Here we provide a discussion of the key practical issues in decision making in the setting of adjuvant chemotherapy for elderly BC patients.

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How to Implement a Geriatric Assessment in Your Clinical Practice

Cited by 63 publications

References 158 publications

Electronic Rapid Fitness Assessment: A Novel Tool for Preoperative Evaluation of the Geriatric Oncology Patient

Electronic Rapid Fitness Assessment: A Novel Tool for Preoperative Evaluation of the Geriatric Oncology Patient

Breast Cancer in Women Older Than 80 Years

Adjuvant chemotherapy in elderly patients with breast cancer: key challenges

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