Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy

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2 Key Points ➤ Approximately 70% of patients with cancer are aged 65 and older. The number of patients with cancer over the age of 65 is projected to significantly increase over the next 20 years. The lifetime probability of developing cancer in men and women aged 70 and over is 1 in 3 and 1 in 4, respectively. ➤ Older patients are especially vulnerable to "over-treatment," i.e., frail patients being provided with cancer treatment with low likelihood of benefit and high likelihood of complications/toxicity, or "under- treatment," i.e., fit older patients who are not provided with standard, evidence-based chemotherapy regimens. Recommendation 1 ➤ In patients age 65 and older receiving chemotherapy, geriatric assessment (GA)—the evaluation of functional status, physical performance and falls, comorbid medical conditions, depression, social activity/support, nutritional status, and cognition—should be used to identify vulnerabilities or geriatric impairments that are not routinely captured in oncology assessments. (Strong Recommendation; EB-B-H) Recommendation 2 ➤ While many tools are appropriate for assessment of each domain, the Expert Panel provided recommendations based on evidence supporting their utility for predicting adverse outcomes and for ease of administration. In patients aged 65 and older receiving chemotherapy, validated and practical GA-based tools can be used to predict adverse outcomes. (Moderate Recommendation; EB-B-H that GA tools predict chemotherapy toxicity and mortality; Moderate Recommendation; EB-B-M to recommend specific tools to evaluate GA domains such as function, comorbidity, depression, cognition, and nutrition.) • The evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition. • The Expert Panel recommends instrumental activities of daily living (IADLs) to assess for function, a thorough history or validated tool to assess comorbidity, a single question for falls, the Geriatric Depression Scale (GDS) to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test (BOMC) to screen for cognitive issues, and assessment of unintentional weight loss to evaluate nutrition. Management

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