Loading
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.
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).
Why: Trials showed that acting on the assessment reduces serious side effects, and problems such as falls or poor nutrition are often missed otherwise.
“All patients with cancer aged 65 and over with geriatric assessment (GA)-identified impairments should have GA-guided management (GAM) included in their care plan.”
ASCO, Journal of Clinical Oncology 2023 · evidence based; evidence quality high; strength strong
Why: These are the areas linked with how older people fare on cancer treatment.
“A GA should include high priority aging-related domains known to be associated with outcomes in older patients with cancer to include assessment of physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support.”
ASCO, Journal of Clinical Oncology 2023 · evidence based; evidence quality high; strength strong
Why: A quick screen finds the people who most need the full assessment.
“Score: 0–14 recommend completing a full geriatric assessment evaluation”
Why: The score combines age, the cancer, the treatment, blood tests and the assessment to predict harm before it happens.
“For Intermediate and High Risk patients, consider administering the full PGA and implement the recommendations noted above based on the patient-reported results”
Why: Other illnesses may shape someone's future more than the cancer, which matters for treatments whose benefit comes years later.
“Based on the best clinical opinion of the Expert Panel, clinicians should use one of the validated tools listed at ePrognosis ( https://eprognosis.ucsf.edu/ ) to estimate life expectancy (LE) greater than or equal to 4 years.”
ASCO, Journal of Clinical Oncology 2023 · informal consensus; strong that it predicts mortality, weak that it improves outcomes or decisions
Why: The point of the assessment is what is done with it: a safer plan and fixes for problems that can be fixed.
“In addition, clinicians should implement targeted, GA-guided interventions to manage nononcologic problems.”
ASCO, Journal of Clinical Oncology 2023 · informal consensus; evidence quality moderate; strength moderate
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
ASCO's 2023 update, read in full, is the most recent guideline and the only one read: geriatric assessment-guided management for everyone aged 65 or over with impairments, extended from chemotherapy to all systemic therapy, on high-quality evidence with a strong recommendation; a GA covering function, cognition, mood, comorbidity, medicines, nutrition and social support; and the Practical Geriatric Assessment as one practical tool. The SIOG and ESMO positions on geriatric assessment were not read, so differences between societies are not stated here.
Where it differs: Uses the 8-item G8 screen (food intake, weight loss, mobility, neuropsychological problems, BMI, prescription drugs, self-rated health and age), with a full GA for scores of 14 or below, rather than a full GA for everyone; the VES-13 is listed as an alternative screen.
Evidence: Listed in ASCO's 2023 table of assessment tools; the GERICO trial cited there enrolled vulnerable patients by G8 of 14 or below.
Where it differs: Uses the Chemotherapy Risk Assessment Scale for High-Age Patients to estimate chemotherapy toxicity risk.
Evidence: ASCO's 2023 table lists CRASH as an alternative tool.
A short structured check of memory, mobility, nutrition and medicines before treatment cuts serious side effects in older patients without reducing benefit. It should be automatic, not optional.
Frailty is the strongest predictor of who will be harmed by treatment, but it is rarely measured. Software can estimate it automatically from existing records and flag patients who need a closer look.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| The Practical Geriatric Assessment as one option “The Panel recommends the Practical Geriatric Assessment (PGA) as one option for this purpose.” | informal consensus; evidence quality moderate; strength weak | ASCO, Journal of Clinical Oncology 2023 |
Shares Geriatric assessment by default for every older patient, and trials that admit them, Dose-finding in older and frail patients, not extrapolation from fit ones, Geriatric assessment by default for every patient over 70 starting cancer treatment, Geriatric assessment.
Shares Geriatric assessment and the tags geriatric-oncology, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.