Should we stop doing comprehensive geriatric assessments in patients under 75 with cancer?

The Older Adults with Cancer Clinic (OACC) performs comprehensive geriatric assessments (CGAs) for patients aged ≥65 with cancer. To manage limited resources and increasing wait times, raising the age cut-off from 65 to 75 was considered. Our objective was to determine whether the CGA has a similar impact on primary and secondary outcomes for patients under 75 compared to those aged 75+.

We performed a retrospective analysis of 1402 consecutive patients aged 65 or older referred from July 2015 to June 2024 in the pre-treatment setting. Data were obtained from a custom clinical database. The primary outcome of the CGA is its impact on the oncology treatment plan, and secondary outcomes include the identification of abnormalities across eight geriatric domains, CGA-based recommendations, and five care enhancements: comorbidity management, cancer treatment delivery, educational support, peri-operative management, and symptom management. Descriptive analytics were used to identify differences in the primary and secondary outcomes of the CGA for patients under 75 versus those ≥75 using chi-square tests.

There was a significant association between age group and treatment changes (χ² = 5.58, p = 0.02). Specifically, 52.2% of patients aged ≥75 experienced a treatment change after the CGA compared to 43.5% of those under 75. Apart from the 'mood' domain (χ² = 7.07, p = 0.008), no notable differences were observed in the percentage of patients with abnormalities across the geriatric domains. Similarly, no significant differences in CGA-based recommendations or care enhancements were found between patients under 75 and those aged ≥75 (all p > 0.05).

Patients aged ≥75 are slightly more likely to undergo treatment changes following the CGA. However, the 43.5% treatment change rate among those under 75 and the lack of differences in secondary outcomes between age groups confirm the value of CGA in improving care for both age groups. Our findings suggest that among patients aged 65 or older, age should not be used to define who might benefit from a CGA.