Most influential comprehensive geriatric assessment factors on geriatricians' advice for cancer treatment in older adults

The aim of this study was to identify which comprehensive geriatric assessment (CGA) domains most influence geriatricians' recommendations regarding cancer treatment in older adults.

This retrospective, cross-sectional study in older adults with cancer who were referred for CGA prior to receiving proposed treatment was conducted in Gelderse Vallei Hospital, the Netherlands, between February 2019 and May 2025. CGA consisted of somatic, psychological, functional, and social domains and goals-of-care. We investigated the association between variables for these domains and recommendation for treatment modification in univariate and multivariate logistic regression. The direction of treatment modification was universally a reduction or de-intensification. Domains explicitly described in the geriatricians' documentation as influencing their treatment advice were also analysed using descriptive statistics.

In total, 245 participants were included; median age was 80 years and 49% were female. The advice to modify cancer treatment was recommended in 59 (24.1%) participants. Variables independently associated with the recommendation to modify initial cancer treatment were: higher Charlson Comorbidity Index (per unit increase: OR 1.37, 95%-CI 1.04-1.81), low Short Physical Performance Battery (score 0-6 vs 10-12: OR 4.12 95%-CI 1.37-12.38), low grip strength (percentile 0th-24th vs ≥75th: OR 8.33 95%-CI 1.75-39.54) and low Mini Nutritional Assessment (score ≤ 7 vs 12 to 14: OR 5.45 95%-CI 1.59-18.76). Domains mentioned as influential in geriatricians' recommendations were functional (13.9%), goals-of-care (13.5%), and psychological (10.2%) domains.

Functional and somatic factors were independently associated with recommendation to modify treatment including low mobility, malnutrition, lower grip strength, and multimorbidity. The functional domain (13.9%) was described most frequently in geriatricians' recommendations, closely followed by the goals-of-care (13.5%).