ASCO Guideline for Geriatric Oncology: Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy

As reported in the Journal of Clinical Oncology by Supriya G. Mohile, MD, of the University of Rochester Medical Center, and colleagues, ASCO has produced a guideline on the practical assessment and management of vulnerabilities in geriatric patients receiving chemotherapy. To develop the guideline, an expert panel undertook a systematic review of the literature, with a total of 68 studies providing the evidence basis for recommendations.

The panel was co-chaired by Dr. Mohile, William Dale, MD, PhD, formerly of the University of Chicago and currently of the City of Hope, Duarte, and Arti Hurria, MD, of City of Hope. Key recommendations are summarized or reproduced below.

Key Recommendations

  • In patients aged ≥ 65 years receiving chemotherapy, geriatric assessment should be used to identify vulnerabilities that are not routinely captured in oncology assessments.
  • Evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition. The panel recommends instrumental activities of daily living (IADL) to assess for function; a thorough history or validated tool to assess comorbidity; a single question for falls; the Geriatric Depression Scale to screen for depression; the Mini-Cog or the Blessed Orientation-Memory-Concentration test to screen for cognitive impairment; and an assessment of unintentional weight loss to evaluate nutrition.
  • Either the CARG (Cancer and Aging Research Group) or CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) tools are recommended to obtain estimates of chemotherapy toxicity risk; the Geriatric-8 or Vulnerable Elders Survey-13 can help to predict mortality.
  • Clinicians should use a validated tool listed at ePrognosis to estimate non–cancer-based life expectancy ≥ 4 years.
  • Geriatric assessment results should be applied to develop an integrated and individualized plan that informs cancer management and to identify nononcologic problems amenable to intervention.
  • Collaboration with caregivers is essential to implementing geriatric assessment–guided interventions. The panel suggests that clinicians take into account geriatric assessment results when recommending chemotherapy and that the information be provided to patients and caregivers to guide treatment decision-making.
  • Clinicians should implement targeted, geriatric assessment–guided interventions to manage nononcologic problems.

Additional information is available at www.asco.org/supportive-care-guidelines.

The corresponding author for the Journal of Clinical Oncology article is ASCO; e-mail: guidelines@asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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