3
Management
• Either the Cancer and Aging Research Group (CARG) or Chemotherapy Risk
Assessment Scale for High-age patients (CRASH) tools are best utilized to obtain
specific estimates on risk of chemotherapy toxicity, while short tools such as G8
or Vulnerable Elders Survey-13 (VES-13) can help predict mortality. Table 1 also
provides alternatives to these options.
Recommendation 3
➤ Based on the best clinical opinion of the Expert Panel, clinicians
should use one of the validated tools listed at ePrognosis (https://
eprognosis.ucsf.edu/calculators.php) to estimate life expectancy (LE)
greater than or equal to 4 years. (Strong Recommendation; IC-B-H
that it predicts mortality; Weak Recommendation; IC-B-Ins that it
improves outcomes or improves decision making)
• The Expert Panel especially recommends either the Schonberg or Lee Index
(https://eprognosis.ucsf.edu/leeschonberg.php). The most common variables
considered in these indices include age, sex, comorbidities (e.g., diabetes, chronic
obstructive pulmonary disease [COPD]), functional status (e.g., activities of
daily living [ADLs], IADLs, mobility), health behaviors and lifestyle factors (e.g.,
smoking status, body mass index), and self-reported health.
• Several indices have "presence of cancer" as a relevant variable, answering "no" to
this question will allow for non-cancer LE, in order to consider competing risks of
mortality.
Recommendation 4
➤ Delphi consensus panels of experts have established approaches for
implementing GA-guided care processes in older adults with cancer.
(Moderate Recommendation; IC-M)
• The Expert Panel recommends that clinicians apply the results of GA with
patients to develop an integrated and individualized plan that informs treatment
selection helping to estimate risks for adverse outcomes (see Recommendation 2),
and to identify non-oncologic problems (e.g., see Recommendation 1) that may be
amenable to intervention.
• Based on clinical experience and the results of formal expert consensus studies,
the Expert Panel suggests that clinicians take into account GA results when
recommending treatment, and that the information be provided to patients
and caregivers to guide decision making for treatment. In addition, clinicians
should implement targeted, GA-guided interventions to manage non-oncologic
problems.
• Consistent with the results of formal modified Delphi consensus studies, the
ASCO Expert Panel supports the specific high-priority GA-guided interventions
outlined in Table 2.
