Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy

Published online ahead of print July 17, 2023. DOI: 10.1200/JCO.23.00933

William Dale, Heidi D. Klepin, Grant R. Williams, Shabbir M.H. Alibhai, Cristiane Bergerot, Karlynn Brintzenhofeszoc, Judith O. Hopkins, Minaxi P. Jhawer, Vani Katheria, Kah Poh Loh, Lisa M. Lowenstein, June M. McKoy, Vanita Noronha, Tanyanika Phillips, Ashley E. Rosko, Tracy Ruegg, Melody K. Schiaffino, John F. Simmons Jr,  Ishwaria Subbiah, William P. Tew, Tracy L. Webb, Mary Whitehead,  Mark R. Somerfield,  and Supriya G. Mohile.

Purpose

To update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy.

Methods 

An Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022.

Results

A total of 26 publications met eligibility criteria and form the evidentiary basis for the update.

Recommendations

The Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (651 years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority agingrelated domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate. The Panel recommends the Practical Geriatric Assessment as one option for this purpose (Practical Geriatric Assessment, How to do a Geriatric Assessment, What to do with the Results of a Geriatric Assessment).

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