Integrating a geriatric evaluation in the clinical setting

Older cancer patients-which make the majority of cancer patients-present with a highly heterogeneous health status. Therefore, a careful assessment of the individual's condition is important in the planning of their oncologic care. In this article, a two-step approach is recommended: a short screening test of every patient presenting for treatment, and a multidisciplinary evaluation for patients screening at risk. Several screening tools that have been tested are described, and their relative performance is reviewed: the abbreviated Comprehensive Geriatric Assessment, the G8, the Senior Adult Oncology Program 2 questionnaire, the Triage Risk Screening Tool, the Vulnerable Elders Survey 13 tool, the Groeningen Frailty Index, and the Onco-Geriatric Screening Tool. Indeed, regular multidisciplinary meetings are key to optimal management of elderly patients, as they modify treatment plans in ¼ to ½ of patients. A practical way of implementing a multidisciplinary consultation is reviewed, and future directions are discussed.