Updated ASCO Guidelines Reiterate the Importance of Geriatric Assessment in Older Patients with Cancer

The American Society of Clinical Oncology (ASCO) has issued an update to its guidelines for the practical assessment and management of vulnerabilities in patients aged ≥65 years receiving systemic cancer treatment. The new recommendations, published in the Journal of Clinical Oncology,¹ build on the Society’s previous guidance, published in 2018.² The Expert Panel that revised the guidelines stressed the importance of conducting a geriatric assessment (GA) to assess an older patient’s physical and cognitive abilities, emotional well-being, coexisting medical conditions, medications, nutrition, and social situation. Based on the results of this assessment, providers may be able to reduce some patients’ cancer therapies, which can help to minimize adverse events and increase supportive care interventions.

“Clinically, the most important conclusion is that it is essential to do a GA for older adults with cancer to provide appropriate care when considering systemic therapy; when GA-guided management is compared with SOC [standard of care], it clearly leads to significantly less chemotherapy toxicity and improves adherence to chemotherapy,” wrote William Dale, MD, PhD, George Tsai Family Chair, Geriatric Oncology; Professor, Department of Supportive Care Medicine; Director, Older Adults Specialized Interdisciplinary Services; and Director, Center for Cancer and Aging, City of Hope, Duarte, CA, and colleagues. “[GA-guided management] also improves important patient-centered outcomes and communication, particularly patient and caregiver satisfaction with care, communications about aging concerns, and completion of advanced directives,” they added.

William Dale, MD, PhD, and colleagues

Clinically, the most important conclusion is that it is essential to do a GA for older adults with cancer to provide appropriate care when considering systemic therapy.

—William Dale, MD, PhD, and colleagues

Key Updates

The updated ASCO guidelines were prompted by the publication of 2 large, randomized clinical trials (Geriatric Assessment for Patients 70 Years and Older³ and Geriatric Assessment-Driven Intervention⁴), which showed an advantage with the use of GAs.

The Expert Panel reiterated the overarching recommendation from the 2018 guidelines that GAs—including all essential domains—should be utilized to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients aged ≥65 years with cancer.¹

In addition, the Panel noted that GAs should include “high priority” aging-related domains, which are known to be associated with outcomes in older adults, such as physical and cognitive ability, emotional health, nutrition, comorbidities, polypharmacy, and social support.¹

The Panel also asserted that while the recommendations were strongest for patients receiving chemotherapy, the guidelines now also address targeted therapy and immunotherapy.

In conjunction with the updated guidelines, ASCO has published 2 videos to help providers incorporate GAs into their practices. “How to Do a Geriatric Assessment” describes how a GA can be conducted in 10 minutes, and “What to Do With the Results of a Geriatric Assessment” explains how the results of a GA can be used to create an individualized treatment plan. These videos, as well as downloadable versions of the Practical Geriatric Assessment and the Action Chart for Practical Geriatric Assessment, and other tools, can be accessed on ASCO’s Geriatric Oncology Resources page (https://old-prod.asco.org/news-initiatives/current-initiatives/geriatric-oncology/resources).

References

1. Dale W, Klepin HD, Williams GR, et al. Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline update. J Clin Oncol. 2023 Sept 10. Epub ahead of print.
2. Mohile SG, Dale W, Somerfield MR, et al. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. J Clin Oncol. 2018;36:2326-2347.
3. Mohile SG, Mohamed MR, Xu H, et al. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet. 2021;398:1894-1904.
4. Li D, Sun C-L, Kim H, et al. Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: a randomized clinical trial. JAMA Oncol. 2021;7e214158.