# Geriatric assessment before systemic cancer therapy in older adults

Source: https://onco.cc/protocols/geriatric-assessment-before-systemic-cancer-therapy/  
OnCo record `geriatric-assessment-before-systemic-cancer-therapy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

If you are 65 or over and about to start chemotherapy, targeted therapy or immunotherapy, your team should check more than the cancer: how well you move and manage day to day, memory, mood, other illnesses, medicines, nutrition and who supports you. The results help choose a treatment you can tolerate and find problems that can be fixed, such as falls, poor nutrition or too many tablets.

## Summary

ASCO (2023) recommends that every person with cancer aged 65 or over with impairments found on geriatric assessment (GA) has GA-guided management in their care plan, using the results both to inform the treatment decision and to address the impairments through interventions, counselling and referrals; this includes chemotherapy, targeted therapy and immunotherapy (evidence based, high quality, strong). The GA should cover physical and cognitive function, emotional health, comorbidities, polypharmacy, nutrition and social support (high, strong); the Practical Geriatric Assessment is one option (informal consensus, weak).

Life expectancy is estimated with a validated tool such as the Lee or Schonberg index from ePrognosis (strong that it predicts mortality; weak that it improves decisions). A G8 screen of 14 or below prompts a full assessment, and the CARG toxicity tool scores the risk of serious chemotherapy toxicity (0 to 5 low, 6 to 9 intermediate, 10 to 23 high); at intermediate or high risk, ASCO's table suggests the full assessment and considering treatment modifications. Clinicians should share GA results with patients and caregivers, and implement targeted interventions for problems outside the cancer (informal consensus, moderate).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: geriatric assessment in oncology; GA-guided management; Practical Geriatric Assessment; G8 screening; CARG chemotherapy toxicity score; assessment of older people before chemotherapy
- Tags: protocol; geriatric-oncology; supportive-care

## Connected records

- ideas: [An automatic electronic frailty index inside the oncology record](https://onco.cc/ideas/idea-acc-electronic-frailty-index-oncology/), [Dose-finding in older and frail patients, not extrapolation from fit ones](https://onco.cc/ideas/idea-tr1-geriatric-dose-finding-cohorts/), [Geriatric assessment by default for every older patient, and trials that admit them](https://onco.cc/ideas/idea-moon-geriatric-assessment-default/), [Geriatric assessment by default for every patient over 70 starting cancer treatment](https://onco.cc/ideas/idea-acc-geriatric-assessment-by-default/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [G8 geriatric screening tool](https://onco.cc/technologies/g8-geriatric-screening/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)

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