Geriatric assessment has emerged as a pivotal tool in optimizing cancer care for older patients, aiming to mitigate treatment toxicity, enhance treatment adherence, and improve quality of life. The recommended areas for evaluation in a geriatric assessment focus on identifying health issues that could impact treatment tolerance and prognosis. These areas include physical functioning, cognitive health, emotional well-being, presence of comorbidities, medication use, nutritional status, and availability of social support.1
Recent findings from studies presented at 2023 International Society of Geriatric Oncology (SIOG) Annual Conference shed light on the effectiveness and cost-effectiveness of geriatric assessment in older cancer populations.
Featured Studies’ Findings
A systematic review and meta-analysis, conducted by Alibhai et al,2,3 evaluated randomized controlled trials comparing comprehensive geriatric assessment with usual care in older patients with cancer. The review included exhaustive searches across seven databases, identifying 17 randomized controlled trials meeting inclusion criteria. No cost--effectiveness studies comparing geriatric assessment with usual care were found.
Adolfo González Serrano, MD, MSc, PhD
Across the 17 randomized controlled trials, patients aged 72 to 80 participated, with sample sizes ranging from 51 to 718. Various cancer types were represented, with treatment modalities including chemotherapy, surgery, radiotherapy, and combination therapies. Although definitions of outcomes varied, findings indicated that geriatric assessment was associated with reduced grade 3 to 5 treatment toxicity, as evidenced by a statistically significant lower risk ratio than usual care (risk ratio = 0.78, 95% confidence interval = 0.70–0.86). However, no significant differences between groups were observed in hospitalization rates or mortality. Quality-of-life outcomes were reported in six randomized controlled trials, with methodologic heterogeneity hindering meta-analysis. Similarly, functional status assessments across eight randomized controlled trials did not demonstrate statistically significant improvements in quality of life between geriatric assessment and usual care.
Addressing cost-effectiveness remains crucial. Compared with the valuable insights provided by geriatric assessment results, the expense associated with geriatric assessment is notably modest in contrast to the numerous diagnostic procedures typically employed in oncologic assessments.4
GUEST EDITOR
Stuart M. Lichtman, MD, FASCO
Dr. Lichtman is Attending Physician (retired) at Memorial Sloan Kettering Cancer Center, Commack, New York; Professor of Medicine at Weill Cornell Medical College, New York; a consultant for Wilmot Cancer Institute Geriatric Oncology Research; and Past President of SIOG. Geriatrics for the Oncologist is developed in collaboration with the International Society of Geriatric Oncology (SIOG).
Of note, a study conducted by Abrahamyan et al, of the University of Toronto, examined the cost-utility of geriatric assessment within the 5C trial, a single-blinded randomized controlled trial involving 350 patients in Canada.5 Results indicated no significant difference in quality-adjusted life years (QALYs) between arms overall. However, when stratified by treatment type, patients treated with curative intent showed a slight increase in QALYs with geriatric assessment, whereas those receiving palliative treatment did not show significant differences.
Furthermore, the team led by Canouï-Potrine et al, of the Paris-East Créteil University, presented a cost-effectiveness analysis at the 2023 SIOG Annual Conference.6 They suggested geriatric assessment may be cost-effective in reducing treatment toxicity compared with geriatric screening and usual care. These findings highlight the potential economic benefits of integrating geriatric assessment into routine oncologic care for older adults.
Closing Thoughts
Insights from recent studies underscore the value of geriatric assessment in optimizing cancer care for older patients. Although geriatric assessment has shown efficacy in reducing treatment toxicity, challenges remain in assessing its impact on broader outcomes such as quality of life and cost-effectiveness. Continued research efforts and interdisciplinary collaboration are essential to provide further evidence of the potential of geriatric assessment in improving outcomes for this vulnerable patient population.
To improve geriatric assessment implementation, the 2023 ASCO guidelines on evaluating and addressing vulnerabilities in older patients receiving chemotherapy introduced an innovative geriatric assessment tool known as the practical geriatric assessment.7 Additional resources concerning the practical geriatric assessment, how to perform it, and what to do with the results have been discussed by Williams et al7 and are available at https://society.asco.org.
DISCLOSURE: Dr. González Serrano reported no conflicts of interest.
REFERENCES
1. Dale W, et al: Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline update. J Clin Oncol 41:4293-4312, 2023.
2. Alibhai S, et al: SIOG2023-4-OA-109–Geriatric assessment in older adults with cancer. J Geriatr Oncol 14:S4, 2023.
3. Anwar MR, et al: Effectiveness of geriatric assessment and management in older cancer patients: A systematic review and meta-analysis. J Natl Cancer Inst 115:1483-1496, 2023.
4. Hamaker ME, et al: Time to stop saying geriatric assessment is too time consuming. J Clin Oncol 35:2871-2874, 2017.
5. Sahakyan Y, et al: Cost-utility analysis of geriatric assessment and management in older adults with cancer: Economic evaluation within 5C trial. J Clin Oncol 42:59-69, 2024.
6. Gonzalez Serrano A, et al: SIOG2023-4-OA-106–Cost-effectiveness of geriatric assessment for reducing treatment toxicity in older cancer patients. J Geriatr Oncol 14:S3-S4, 2023.
7. Williams GR, Hopkins JO, Klepin HD, et al: Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline questions and answers. JCO Oncol Pract 19:718-723, 2023.
Dr. González Serrano, whose areas of expertise are urology, oncology, and oncogeriatrics, practices at the Hospital Universitari Son Espases, Palma, Spain.
