An expert panel has updated the guideline of the American Society of Clinical Oncology for practical assessment and management of vulnerabilities in older adults receiving systemic cancer chemotherapy. The revision was prompted by “the publication of two large randomized clinical trials (RCTs), Geriatric Assessment for Patients 70 Years and Older (GAP70+) and Geriatric Assessment-Driven Intervention (GAIN) that evaluated whether integration of geriatric assessment (GA) and GA-guided management (GAM) would reduce serious chemotherapy-related toxic effects in older adults with cancer,” the panel writes.
Key recommendations in the updated guideline include the following:
Recommendation 1.1
All patients with cancer age 65 years and over with GA-identified impairments should have GAM included in their care plan. GAM includes using GA results to (1) inform cancer treatment decision-making, and (2) address impairments through appropriate interventions, counseling, and/or referrals.
Amendment 1.1a.
This includes older adults receiving systemic therapy, including chemotherapy, targeted therapy, and/or immunotherapy (Type: Evidence based, benefits outweigh harms; Evidence quality: High; Strength of recommendation: Strong).
Recommendation 2.1
A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer to include assessment of physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support (Type: Evidence based, benefits outweigh harms; Evidence quality: High; Strength of recommendation: Strong).
Recommendation 2.2
The Panel recommends the Practical Geriatric Assessment (PGA) as one option for this purpose. See the PGA tool at: https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf. See how to use the PGA tool at: https://youtu.be/jnaQIjOz2Dw; and https://youtu.be/nZXtwaGh0Z0 (Type: Informal consensus; Evidence quality: Moderate; Strength of recommendation: Weak).