Geriatric assessment by default for every patient over 70 starting cancer treatment

Overview

• Protocol upgrade, graded proven but unevenly used. GAP70+ cluster-randomised 40 community practices and 718 patients aged 70 or over: grade 3 to 5 toxic effects occurred in 51 per cent with a geriatric assessment summary and management recommendations against 71 per cent with usual care (relative risk 0.74), with fewer falls. GAIN randomised 613 patients aged 65 or over at one centre: grade 3 or higher chemotherapy toxicity was 50.5 per cent against 60.6 per cent, with no difference in overall survival. ASCO's 2023 update reiterates that geriatric assessment should be used for older patients starting systemic therapy.
• Adoption gap, as measured: in a 2019 to 2020 survey of 349 United States oncologists, 60 per cent did not use a formal geriatric assessment for any of their older patients, most often calling it too cumbersome (44 per cent) or of no added value (36 per cent) (Gajra, 2022). In four French centres, 51 of 131 men with metastatic prostate cancer and an indication for geriatric assessment before docetaxel received one (38.9 per cent), the commonest barrier being the absence of systematic screening (GAMERS, 2023).