NEARLY 60% OF CANER DIAGNOSES are in people over the age of 65, but oncologists’ knowledge about treating older patients, who often have a range of other health issues, can vary widely.
Supriya Mohile, a geriatric oncologist at the Wilmot Cancer Institute at the University of Rochester Medical Institute in New York, recently led the GAP70+ study, which looked at the effects of using geriatric assessment to guide care for 718 people over 70 with advanced cancer and aging-related conditions. The results, published in the Lancet in November 2021, revealed that patients receiving geriatric assessment-guided treatment experienced fewer toxic effects from cancer treatment.
Researchers split participants into two groups: one that received a geriatric assessment at the beginning of cancer care and one that did not. They found that geriatric assessment intervention led oncologists to prescribe lower doses of chemotherapy in the first round of treatment and offered patients similar survival outcomes. Patients who received assessment also had fewer falls and more medications discontinued.
Older cancer patients with advanced cancer and other age-related conditions are at higher risk of experiencing toxic effects, such as falling, hospitalization and disruptive effects on memory and thinking, the study noted. Geriatric assessment is a tool for oncology teams to examine a patient’s mobility, medications and cognitive processing. The information from that assessment can be used along with conversations around a patient’s goals and overall health to make informed treatment decisions. It also results in recommendations for supportive services, such as physical therapy, occupational therapy and nutritional counseling.
“My patients will [say], ‘It’s very important to me that I make it to this wedding in June. If my treatment means I cannot, I don’t want to do it,’” says Rawad Elias, who is both a trained geriatrician and oncologist at Hartford HealthCare Cancer Institute in Connecticut. “I am their cab driver—they tell me where they want to go, and my job is to make that ride as comfortable as possible. I can [do that better] with geriatric assessment data.”
Despite these results, geriatric assessment remains uncommon in clinical practice. Elias notes that grant funding allows researchers to hire dedicated personnel to conduct geriatric assessments—something many community cancer centers cannot necessarily afford to do. But both Mohile and Elias stress that geriatric assessment efforts can be scaled up or down, depending on a practice’s available resources. “[Clinics] have to do what they can,” Mohile says. “If they cannot do the full geriatric assessment, there are shorter screening tools to use.”
Mohile would also like to see more research into how geriatric assessment impacts older patients with early-stage cancers and have these measures incorporated. “If we know geriatric assessment helps guide management, we should put it in therapeutic trials to ensure those patients get the best care possible,” she says.
“We have to think of creative ways to get geriatric assessment to our patients,” Elias says. Elias has integrated geriatric assessment elements into the medical record software system at his practice. So, if a care provider reports that a person being treated for cancer experienced a fall, the software automatically prompts that provider to refer the patient to physical therapy. While the system requires some training, it does not require a dedicated geriatrician, since the software has a geriatric assessment tool running in the background at all times.
“It’s kind of mind-blowing that we are accepting lower than acceptable care [for older adults],” Elias says. “If chemo can cause cardiac toxicity, you need an echo[cardiogram] before treatment. It’s unacceptable to [prescribe chemo] without one. But it is [somehow] acceptable to put an older patient through the toxicity without a [geriatric] assessment?”
While Mohile and Elias work to move the needle on geriatric cancer care through their research, they encourage patients and their caregivers to advocate for geriatric assessment with their care teams. “If it was my grandmother, I’d say, ‘I want this. I am going to find a doctor who can do it,’” Mohile says. “If [geriatric assessment] is being asked for, that might increase the number of community oncology practices who invest in it.”
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