Integrating a Geriatric Evaluation in the Clinical Setting

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Older cancer patients—which make the majority of cancer patients—present with a highly heterogeneous health status. Therefore, a careful assessment of the individual's condition is important in the planning of their oncologic care. In this article, a two-step approach is recommended: a short screening test of every patient presenting for treatment, and a multidisciplinary evaluation for patients screening at risk. Several screening tools that have been tested are described, and their relative performance is reviewed: the abbreviated Comprehensive Geriatric Assessment, the G8, the Senior Adult Oncology Program 2 questionnaire, the Triage Risk Screening Tool, the Vulnerable Elders Survey 13 tool, the Groeningen Frailty Index, and the Onco-Geriatric Screening Tool. Indeed, regular multidisciplinary meetings are key to optimal management of elderly patients, as they modify treatment plans in ¼ to ½ of patients. A practical way of implementing a multidisciplinary consultation is reviewed, and future directions are discussed.

Section snippets

Introduction: The Two-Step Approach

It is now well established that older cancer patients present a significant prevalence of geriatric problems. Approximately 20% have an Eastern Cooperative Oncology Group performance status (PS) of ≥2. An equal proportion of patients have a dependence in basic activities of daily living (ADL). More than half have a dependence in instrumental activities of daily living (IADL). More than 90% have at least 1 comorbidity, and 30%-40% of those comorbidities are severe. Depression is present in

Short Screening Tools

These are rapid triage tools taking only a few minutes to answer. This is an area in active development, and the list that follows does not claim to be exhaustive. However, some instruments that were used and tested in recent articles are described in the following sections.

Step 2: Integrated Geriatric Oncology Management

Once a patient screens positive for geriatric problems a combined oncogeriatric approach should be set up. This can take several formats. The International Society of Geriatric Oncology (SIOG) recently presented its list of the 10 Global Priorities to address the care of older cancer patients.29 Among them is to “Develop interdisciplinary geriatric oncology clinics, especially in academic institutions and comprehensive cancer centers.” We believe that major centers should have geriatric

Risk Prediction Models

The prediction of treatment outcome in a situation where multidimensional variables occur, as with the older patient, is difficult. Trained oncologists have difficulty integrating in their treatment plan >3 variables at one time.31 Our interpretation of the patient's desires might be biased by cultural expectations,32, 33 and our reading of the literature is selective due to time constraints. Therefore, good quality decision models based on systematic reviews of available data are very valuable.

Recommendations, Perspectives, Research Needed

In summary, there is an increasing amount of evidence that geriatric parameters should be considered when planning cancer treatment. We recommend identifying or setting up a local oncogeriatric team in an appropriate format. Even if the volume of consultations might initially be low, the effect is likely to be multiplied by a mutual educational process. We recommend choosing 1 short screening tool assessing several geriatric domains in conjunction with the local geriatric support to optimize

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