Use of Geriatric Assessment for Older Adults in the Oncology Setting: A Systematic Review

Abstract

BackgroundGeriatric assessment is a multidisciplinary diagnostic process that evaluates the older adult’s medical, psychological, social, and functional capacity. No systematic review of the use of geriatric assessment in oncology has been conducted. The goals of this systematic review were: 1) to provide an overview of all geriatric assessment instruments used in the oncology setting; 2) to examine the feasibility and psychometric properties of those instruments; and 3) to systematically evaluate the effectiveness of geriatric assessment in predicting or modifying outcomes (including the impact on treatment decision making, toxicity of treatment, and mortality).MethodsWe searched Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library for articles published in English, French, Dutch, or German between January 1, 1996, and November 16, 2010, reporting on cross-sectional, longitudinal, interventional, or observational studies that assessed the feasibility or effectiveness of geriatric assessment instruments. The quality of articles was evaluated using relevant quality assessment frameworks.ResultsWe identified 83 articles that reported on 73 studies. The quality of most studies was poor to moderate. Eleven studies examined psychometric properties or diagnostic accuracy of the geriatric assessment instruments used. The assessment generally took 10–45min. Geriatric assessment was most often completed to describe a patient’s health and functional status. Specific domains of geriatric assessment were associated with treatment toxicity in 6 of 9 studies and with mortality in 8 of 16 studies. Of the four studies that examined the impact of geriatric assessment on the cancer treatment decision, two found that geriatric assessment impacted 40%–50% of treatment decisions.ConclusionGeriatric assessment in the oncology setting is feasible, and some domains are associated with adverse outcomes. However, there is limited evidence that geriatric assessment impacted treatment decision making. Further research examining the effectiveness of geriatric assessment on treatment decisions and outcomes is needed.

Utility of the Edmonton Frail Scale in identifying frail elderly patients during treatment of colorectal cancer

“…Identifying factors that place patients with cancer at risk for frailty may help oncologists tailor treatment decisions to their individual patients (11,12). The comprehensive geriatric assessment (CGA) is considered by many to be the "gold standard" and is an effective clinical tool for identifying frailty in elderly patients (13,14).…”

Multicenter implementation of geriatric assessment in Belgian patients with cancer: A survey on treating physicians' general experiences and expectations

“…choice of therapy, treatment complications, evolution of functionality and quality of life, (overall) survival, etc.). [2][3][4][5][6] This can be related to important heterogeneity of the older population and lack of appropriate care standards caused by insufficient accrual of older persons in clinical trials. As a consequence, published data report on non-evidence based adjustments of treatment guidelines and increased likelihood of under-treatment with a possible negative effect on survival.…”

“…As a consequence, published data report on non-evidence based adjustments of treatment guidelines and increased likelihood of under-treatment with a possible negative effect on survival. [6][7][8] Implementation of the CGA (comprehensive geriatric assessment), which has been shown beneficial for several outcomes in acute geriatric care wards, 9,10 is considered to be the most appropriate way to adapt to the multiple needs and restrictions of older patients. 11 This method comprises four consecutive steps: (i) identifying patients who can benefit from a CGA; (ii) assessing these patients; (iii) developing recommendations for geriatric interventions based on the detected problems by the CGA; and (iv) implementing these recommendations.…”

Specialist geriatric services: A necessity within the radiotherapy workforce

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