Impact and Feasibility of a Comprehensive Geriatric Assessment in the Oncology Setting

Abstract

Several factors limited the feasibility of a consultation-type geriatric-oncology service to assess older cancer patients. The impact of CGA in informing treatment decisions was modest but may be of value when the initial treatment decision is uncertain.

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

“…7 These geriatric assessment tools were subsequently simplified and transferred to oncology clinics for the assessment of older patients with cancer. [8][9][10] As shown in Table 1, a geriatric assessment includes an assessment of several domains, including functional status, psychological health, polypharmacy, comorbidity, nutrition, social support, and cognition. There are several well-validated tools available to assess these domains.…”

“…49,50 In these studies, 2% to 28% of patients had changed to more intensive treatment, whereas 17% to 37% had changed to less intensive treatment. 10,[50][51][52][53] Third, geriatric assessment identifies areas where interventions can be performed, such as dietary advice, physical therapy, and social support, which can help patients tolerate and complete prescribed systemic therapy. Kalsi and colleagues 54 compared the outcomes of older patients who underwent chemotherapy and who received interventions on the basis of issues that were identified on a geriatric assessment with those patients who received standard oncology care.…”

Patterns of care and treatment outcomes in older patients with biliary tract cancer.

“…Given the heterogeneity of the older population, integrating assessments to better biologically stage these patients should lead to better treatment decisions. There is a growing body of evidence supporting the use of comprehensive geriatric assessments in guiding treatment decisions in older patients with cancer [27][28][29][30][31][32] and in addition, there are assessment tools available to better predict tolerance and toxicity to chemotherapy in this population [33,34]. Treatment decisions for BTC in older patients should thus not be guided solely by the biological age of the patient, and active management should be considered for this patient population if deemed appropriate following clinical assessment.…”

Vejez y cáncer de mama, el desafío del siglo 21

“…Un instrumento propuesto para estimar la reserva funcional y la expectativa de vida es una evaluación multidimensional del envejecimiento conocida como CGA (Comprehensive Geriatric Assessment) 43,44 . El CGA incluye: evaluación de comorbilidades, condiciones socioeconómicas como transporte, cuidados domiciliarios y facilidad de ayuda en caso de urgencias; evaluación de dependencia funcional, de condiciones emocionales y cognitivas, y estimación de expectativa de vida.…”

“…Sin embargo, no existen estudios de distribución aleatoria que demuestren la utilidad de esta escala de evaluación o similares, a pesar de que el sentido común y estudios observacionales lo apoyan [44][45][46] (Tabla 9).…”