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
