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Comprehensive Geriatric Assessment

Chapter 3 - Evaluation of the Senior Cancer Patient: Comprehensive Geriatric Assessment and Screening Tools for the Elderly

Further assessment is needed if a patient screens positive using the short screening tools described above. The format for further assessment is highly dependent on the local resources: some institutions have an embedded geriatric oncology team; others have a geriatric consultation service; other centres have combined outpatient visits by a geriatrician and an oncologist; in other settings, the only option might be for the medical team to add geriatric instruments to its oncologic evaluation.

Important domains in a GA are functional status, comorbidity, cognition, mental health status, nutrition, social status and support, fatigue, and assessment for polypharmacy and presence of geriatric syndromes. Various tools are available for assessing these domains.

There are strong general data on the effectiveness of geriatric interventions. What are the data specific to cancer patients? Here again, SIOG has published a recent update of its 2005 guidelines. Besides the ability of CGA to detect unidentified problems, there is now solid evidence that these problems affect prognosis independently from classic oncology predictors. CGA items can predict survival or treatment complications. More research still needs to be done on its ability to predict functional and QoL outcomes in cancer patients. There are now several studies demonstrating that a CGA/geriatric consultation modifies the management of cancer patients (Table below).

Treatment modifications by CGA. Studies reporting changes from a baseline oncology treatment plan

Study# Patients    InterventionTreatment changesComments
Aliamus49GA44.9%
Aparicio21Mini CGA0%
72% adaptation of non-oncological treatment
Caillet375Referral to geriatrician, extensive CGA, multidisciplinary meeting20.8% intensification of cancer treatment (n= 8, 10.2%), delayed cancer treatment to allow geriatric management (n= 7, 9.0%), and decrease in cancer treatment intensity (n= 63, 80.8%;
Chaibi161Full geriatric consultation79 pts (49%)
Delayed therapy in 5 patients, less intensive therapy in 29 patients and more intensive therapy in 45. 76% of patients had a geriatric therapeutic intervention
Decoster902GA by trained nurse, filed in chart.42.2% oncologists modified treatment based on age (44.2% in the subgroup where they consulted the GA)

Based on GA, 6.1% did extra modification.

The judgment as to whether the treatment was modified due to age or the GA was rated by the oncologists a posteriori.
Girre105Geriatric oncology consultation38.7%
Horgan30CGA by oncologist and geriatrician in a common clinic20%
Kenis1967Screening with G8, if +, GA by trained nurse or health care worker. Result filed in chart25.3% influenced treatment decision

51.2% detection of unknown geriatric problems.

61.3% of physicians aware of G8/CGA at time of treatment decision
Weighted average362021.5%

The average rate of modifications is 21.5% (range: 0-49%). This does not count ancillary interventions aimed at non-cancer geriatric problems. The changes may be either intensification or de-escalation of treatment. This might also allow effective prehabilitation or rehabilitation around oncology treatment.

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