Comprehensive Geriatric Assessment

Darryl Wieland, PhD, MPH; Victor Hirth, MD, MHA

Disclosures

Cancer Control. 2003;10(6) 

In This Article

Applicability of Comprehensive Geriatric Assessment to Clinical Oncology

We cannot provide here a full review of the role of CGA in the management of elderly cancer patients; more extensive treatments of this topic have been published elsewhere.[3,39,65,66] However, given the CGA process described here, several points can be made concerning a research and practice agenda.

We cannot expect all older cancer patients to benefit from CGA, but which subsets are likely to benefit? Clinical oncology is in no better position than other subspecialties in knowing which of its treatments are applicable to the benefit of its older patients, partly because elderly patients with cancer and other comorbid conditions -- not to mention "geriatric" syndromes, impairments, or disabilities -- are often excluded from clinical trials, and also because they may not be offered oncologic treatments due to untested assumptions about toxicities and poor prognosis. Under these circumstances, comprehensive geriatric and multidimensional assessment may improve the knowledge base in determining which older patients with cancer may benefit from active cancer treatment and who may benefit from clinical oncologic and geriatric co-management. A more accurate evaluation of prognostic indicators that includes CGA parameters could lead to a higher number of older patients being included in clinical cancer trials and being treated effectively in practice. It would also indicate whom to target among the frail, impaired, and disabled for gero-oncologic CGA and ongoing management aimed at maintaining function and community living. While there is much to learn about targeting CGA in older cancer patients, the development and interest in clinical geriatric oncology make it reasonable to consider whether cancer patients over a certain age -- perhaps 80 years -- should routinely undergo multidimensional geriatric screening in health-care settings where expertise in geriatric assessment and consultation is available.

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