Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Questions and Answers

Williams, Grant R.; Hopkins, Judith O.; Klepin, Heidi D.; Lowenstein, Lisa M.; MacKenzie, Andrew; Mohile, Supriya G.; Somerfield, Mark R.; Dale, William

doi:10.1200/op.23.00263

Cited by 31 publications

(4 citation statements)

References 41 publications

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“…For this reason, a proper evaluation of the health status of older patients with ABC, starting with a frailty screen, or when it is possible, with a comprehensive geriatric assessment should be at the basis of treatment decision making [ 166 , 169 ]. Polypharmacy is common, especially in unfit patients, and therefore special attention should be given to potential interactions when prescribing anticancer agents [ 170 , 171 ]. Real-world data indicate that up to 70 % of older patients with ABC are at potential risk of frailty [ 172 ].…”

Section: Methodsmentioning

confidence: 99%

6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7)

Cardoso,

Paluch-Shimon,

Schumacher-Wulf

et al. 2024

The Breast

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Section: Methodsmentioning

confidence: 99%

6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7)

Cardoso,

Paluch-Shimon,

Schumacher-Wulf

et al. 2024

The Breast

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“…The tools chosen through the Delphi process 69 provide usable information on which to act. The ASCO Older Adults Task Force, in conjunction with SIOG and CARG, has also created additional resources, including a companion article 91 detailing the PGA with scoring instructions, suggestions for actions to take based on the scoring, video guidance on how to conduct the PGA, and references for evidence to support its use. Through ASCO's website, there are updated details on how to use the information generated.…”

Section: Clinical Interpretationmentioning

confidence: 99%

“…70 Given that clinical judgment has not proven reliable in assessing frailty, the PGA is recommended to be used as the appropriate evaluation for older adults. Specific questions on the use of the PGA are also contained in a companion article by Williams et al 91 in JCO Oncology Practice. The Panel acknowledges the challenges of adopting a new practice, and recognizes that judgment will be exercised by individual practices on how best to incorporate these assessments as much a possible into their practices.…”

Section: Clinical Interpretationmentioning

confidence: 99%

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

Dale

Klepin

Williams

et al. 2023

JCO

139

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PURPOSE To update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy. METHODS An Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022. RESULTS A total of 26 publications met eligibility criteria and form the evidentiary basis for the update. RECOMMENDATIONS The Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (65+ years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate. The Panel recommends the Practical Geriatric Assessment as one option for this purpose ( https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf ; https://youtu.be/jnaQIjOz2Dw ; https://youtu.be/nZXtwaGh0Z0 ). Additional information is available at www.asco.org/supportive-care-guidelines .

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“…Similarly, the 2018 ASCO guidelines on geriatric oncology do not provide the tools to be used, but they do specify the essential assessments that should be conducted [58]. However, these guidelines have been updated recently, in 2023, in light of the results of various clinical trials, which have demonstrated that GAM can improve clinical outcomes [10,67]. In this update, it is recommended that all cancer patients over the age of 65 who are going to receive chemotherapy, as well as immunotherapy or targeted therapies, should undergo GA.…”

Section: Comprehensive Geriatric Assessmentmentioning

confidence: 99%

The Five “Ws” of Frailty Assessment and Chronic Lymphocytic Leukemia: Who, What, Where, Why, and When

González-Gascón-y-Marín,

Ballesteros-Andrés,

Martínez-Flores

et al. 2023

Cancers

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Chronic lymphocytic leukemia (CLL) is a disease of the elderly, but chronological age does not accurately discriminate frailty status at the inter-individual level. Frailty describes a person’s overall resilience. Since CLL is a stressful situation, it is relevant to assess the patient´s degree of frailty, especially before starting antineoplastic treatment. We are in the era of targeted therapies, which have helped to control the disease more effectively and avoid the toxicity of chemo (immuno) therapy. However, these drugs are not free of side effects and other aspects arise that should not be neglected, such as interactions, previous comorbidities, or adherence to treatment, since most of these medications are taken continuously. The challenge we face is to balance the risk of toxicity and efficacy in a personalized way and without forgetting that the most frequent cause of death in CLL is related to the disease. For this purpose, comprehensive geriatric assessment (GA) provides us with the opportunity to evaluate multiple domains that may affect tolerance to treatment and that could be improved with appropriate interventions. In this review, we will analyze the state of the art of GA in CLL through the five Ws.

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Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Questions and Answers

Cited by 31 publications

References 41 publications

6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7)

6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7)

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

The Five “Ws” of Frailty Assessment and Chronic Lymphocytic Leukemia: Who, What, Where, Why, and When

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