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Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO
William Dale1, Heidi D Klepin2, Grant R Williams3
1City of Hope National Medical Center, Duarte, CA.
Summary
Geriatric assessment (GA) is recommended for all older cancer patients to identify vulnerabilities. Geriatric assessment-guided management (GAM) should be integrated into care plans for those with identified deficits to improve outcomes.
Area of Science:
- Geriatric Oncology
- Evidence-Based Medicine
- Clinical Practice Guidelines
Background:
- The American Society of Clinical Oncology (ASCO) guideline on assessing and managing age-associated vulnerabilities in older cancer patients requires updating.
- Older adults undergoing cancer therapy often have complex needs not routinely addressed by standard oncology assessments.
Approach:
- A systematic review of randomized clinical trials, systematic reviews, and meta-analyses published between January 2016 and December 2022 was conducted.
- An Expert Panel evaluated 26 eligible publications to form the evidentiary basis for the updated guideline.
Key Points:
- Geriatric assessment (GA), encompassing essential domains, should be universally applied to identify vulnerabilities in cancer patients aged 65 and older.
- Geriatric assessment-guided management (GAM) is recommended for older adults with GA-identified deficits to improve clinical outcomes.
- Key domains for GA include physical and cognitive function, emotional health, comorbidities, polypharmacy, nutrition, and social support.
Conclusions:
- The updated ASCO guideline emphasizes the integration of GA and GAM into the care of older adults with cancer.
- GAM involves using GA findings to guide cancer treatment decisions and address identified impairments through interventions, counseling, and referrals.
- Clinical adaptation of GA is permissible based on patient population, resources, and time constraints.
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