Impact of Age and Comorbidities On Therapeutic Decision-making Among Older Patients With Gastrointestinal Cancer

The impact of age, comorbidities and geriatric syndromes is often overlooked during tumor board (TB) decisions. We investigated how frequently age, comorbidities, functional and nutritional parameters, and frailty are mentioned when deciding treatments for older adults with gastrointestinal (GI) cancers, and the impact these variables have on adherence to TB decisions and treatment guidelines from the European Society for Medical Oncology (ESMO).

Cross-sectional study of data from patients aged ≥ 65 years presented before the GI-TB of a tertiary cancer center between July 2019 and December 2022 based on electronic health records and TB documentation. Mention of age, comorbidity, functional and nutritional parameters, and frailty at decision-making, and adherence to TB decisions and treatment guidelines were assessed.

418 patients with a mean age of 77 years and Charlson Comorbidity Index (CCI) of 8.6 were included. Geriatric variables were mentioned in 43.8% of cases. Among these, comorbidities were mentioned in 17.2%, whereas age was mentioned in 14.6%. Adherence to TB decisions was 82%, whereas adherence to ESMO guidelines was 69%. Mention of age and comorbidity was associated with a 2-fold and 3-fold reduction in the likelihood of adherence to ESMO guidelines (p = 0.02 and 0.001, respectively). This association was not found when analysing adherence to TB decisions.

Geriatric variables, despite being often neglected at the time of defining treatment for the older adult with cancer, can have an effect on oncologic decision-making. Our findings underscore the need for integrating assessment of geriatric variables into oncologic care to support individualized, guideline-concordant treatment planning that reflects the complexity and needs of this population.