In a study of a population of predominantly community-based oncologists reported in JCO Oncology Practice, Ajeet Gajra, MD, and colleagues found that a majority of oncologists surveyed did not use a formal geriatric assessment instrument to assist in treatment decisions for older patients with cancer.
As stated by the investigators, “The use of a standardized geriatric assessment to inform treatment decisions in older adults with cancer improves quality of life, reduces treatment-related toxicity, and is guideline-recommended.”
Ajeet Gajra, MD
Study Details
The study group consisted of U.S.-based oncologists from all geographic regions of the country who attended live meetings of the Cardinal Health Oncology Provider Extended Network between September 2019 and March 2020. Participants completed web-based surveys designed to collect information on treatment decision-making and practice-based challenges in oncology care.
Key Findings
Among 349 oncologists surveyed, 74% practiced in a community setting.
Overall, 60% of oncologists did not use a formal geriatric assessment to inform treatment decisions for any of their older patients; the most common reasons cited for not using a geriatric assessment instrument were “Too cumbersome to incorporate into routine practice” (44%) and “Adds no value beyond the comprehensive history and physical exam” (36%).
Among 80 oncologists with ≤ 10 years in practice, 53% reported using a geriatric assessment for their geriatric patients, with 15% using it for all older patients and 38% using it for some. Among 269 oncologists with > 10 years in practice, 37% reported using a geriatric assessment, with 12% using it for all older patients and 25% using it for some.
Validated geriatric assessment or related instruments recognized by the participants included the Mini-Mental State Exam (MMSE; 63%), Comprehensive Geriatric Assessment (37%), and Cancer and Aging Research Group (CARG) tool (22%). Outside the setting of a clinical trial, the most frequently used validated instruments were MMSE (54%), Comprehensive Geriatric Assessment (23%), CARG tool (12%), and Chemotherapy Risk Assessment Scale for High-Age Patients (9%). A total of 19% participants were unaware of any of the geriatric assessment instruments; 33% had not used any outside the setting of a clinical trial.
For older patients, the most commonly used tools to aid in treatment decisions were Eastern Cooperative Oncology Group performance status (88%) and comorbidities (73%).
The investigators concluded, “Many oncologists have not incorporated geriatric assessment tools because of perceptions that geriatric assessments are difficult to implement or do not add any value. Increasing education of the benefits of geriatric assessment–directed therapy could help to increase geriatric assessment utilization among community oncologists.”
Dr. Gajra, of Cardinal Health Specialty Solutions, Dublin, Ohio, is the corresponding author for the JCO Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
