Geriatric Assessments Could Fine-Tune Cancer Care For Older Adults
In a move to improve cancer care for older adults, the American Society of Clinical Oncology is recommending that all patients age 65 and older receive a geriatric assessment when considering or undergoing chemotherapy.
The goal is to better identify which patients can tolerate intensive chemotherapy, and which patients may need modified treatment regimens because of underlying conditions, such as cognitive impairment, that often go undetected by oncologists.
Fewer than 25 percent of older cancer patients currently get these assessments, which evaluate a person’s functioning (what he can and cannot do), psychological status, nutrition, cognition, social circumstances and other, coexisting medical conditions, and which can predict the potential toxicity of chemotherapy.
The new guideline, ASCO’s first in the field of “geriatric oncology,” may have significant potential to change medical practice. “These recommendations will capture the attention of oncologists, I think, and that will be incredibly valuable,” said Corinne Leach, strategic director of cancer and aging research at the American Cancer Society.
They recognize a shifting demographic reality for cancer specialists, who are treating increasingly older patients as life spans lengthen across the globe. In the U.S., 60 percent of patients newly diagnosed with cancer (an estimated 1.7 million people this year) are age 65 or older, as are more than 60 percent of cancer survivors.
Yet evidence about how best to treat older adults with cancer is weak because older adults are underrepresented in clinical trials. And most oncologists have received little training in how to manage older patients’ unique vulnerabilities.
When researchers asked 305 community oncologists about evaluating older patients, 89 percent acknowledged “the care of older adults with cancer needs to be improved,” according to a recently published study. Fewer than 25 percent said they were “very confident” they could identify dementia or accurately assess a patient’s functioning or risk of falling — factors associated with poorer outcomes for cancer treatment.
Still, resistance to change is evident. “We’re all inundated with trying to keep up with new standards of care, and I doubt there will be any broad acceptance of the rigor called for in this guideline,” said Dr. Frederick Schnell, medical director of the Community Oncology Alliance.