New Global Survey Finds More Education Needed to Increase Provider Geriatric Assessments for Older Adults with Cancer

Providers Familiar with ASCO Guideline on Older Adults with Cancer More Than Twice As Likely to Conduct Geriatric Assessment
October 16, 2020

Oncology providers familiar with the American Society of Clinical Oncology’s (ASCO) guideline on older adults with cancer are two to four times more likely to conduct a geriatric assessment on patients with cancer over the age of 65, according to the first international ASCO survey aimed at determining if and how often cancer providers are using geriatric assessments when treating older adults. This is a noteworthy finding, according to ASCO, because nearly 70% of patients with cancer in the United States are 65 years of age or older, and globally, the number of new cancer cases per year among older adults will exceed 13 million by 2030.

“Cancer is predominantly a disease of aging, and as our population grows older, there’s an urgent need to equip clinicians who treat older adults with cancer with tools to assess the array of factors that may impact care,” said ASCO President Lori J. Pierce, MD, FASTRO, FASCO. “ASCO’s work in this area underscores the importance of cancer care teams understanding the value of geriatric assessments in improving care management decisions for older adults.”

In 2018, ASCO published a guideline entitled Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy, which recommends that cancer care providers conduct a geriatric assessment on all patients 65 years or older to identify vulnerabilities (such as function, comorbidity, falls, depression, cognition, and nutrition) that are not routinely captured in oncology assessments. The guideline also recommends specific tools providers can use to conduct these geriatric assessments.

Survey Findings

The survey, which was published in JCO® Oncology Practice, found more than half (53%) of respondents were familiar with the ASCO guideline. Of those, 69% used geriatric assessment tools to assess functional status of older adults with cancer, compared to 50% of those who were not familiar with the guideline.

Respondents aware of the guideline noted that the biggest barrier to using geriatric assessment tools was a lack of resources, including time (81.7%) and trained staff (77.0%), while those unaware of the guideline reported a lack of knowledge/training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%).

Nearly two-thirds of respondents (63%) reported that they “always” or “most of the time” assess older patients differently than younger patients when making clinical management decisions including using specific validated tools (29%) or using informal assessments based on their own judgment (69%).

Evidence is emerging that geriatric assessment can lead to changes in clinical management and improved outcomes for older adults with cancer. Recent studies have demonstrated that if oncologists were aware of geriatric assessment results indicating a patient had a functional or cognitive impairment, they would be less likely to give full-dose chemotherapy1,2,3,4. Another study, which was presented at ASCO’s Annual Meeting in 2020, found that use of geriatric assessments in routine care of older adults with advanced cancer significantly improved doctor-patient communication about age-related concerns, as well as increased patient satisfaction with the communication.

“We know that a geriatric assessment gives vital information to support cancer care providers in guiding treatment choices for older adults,” said William Dale, MD, PhD, Co-Chair of ASCO’s Addressing Cancer Health Disparities Among Older Adults Task Force. “We hope that by highlighting perceived barriers among providers to using geriatric assessments, they will seek out available guidance, such as the ASCO geriatric oncology guideline, and adopt the simple tools as part of routine cancer care.”

ASCO’s Ongoing Work in Support of Older Adults with Cancer

ASCO has undertaken a multi-pronged strategy to improve the evidence base for treating older adults with cancer, to enhance education and training for oncology providers, and to create guidelines aimed at improving the quality of care for older adults with cancer. ASCO published a set of recommendations focused on ensuring clinicians and patients have the information they need to develop treatment plans for this population, and in 2017, the Society and the U.S. Food and Drug Administration (FDA) co-hosted a public workshop focused on building collaborations and developing new action items to increase the evidence base for treating older adults with cancer. Due in large part to these activities, FDA recently issued draft guidance to encourage inclusion of older adults in cancer clinical trials – an important signal to researchers and sponsors that older adults with cancer should be enrolled in clinical trials when they can do so safely and ethically.

The ASCO survey was conducted online between April 5, 2019 and June 5, 2019. Responses from 1,240 providers across the globe who care for older adults with cancer were analyzed for this report.

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Gajra A, Loh KP, Hurria A, et al: Comprehensive Geriatric Assessment-Guided Therapy Does Improve Outcomes of Older Patients With Advanced Lung Cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 34:4047-4048, 2016

Corre R, Greillier L, Le Caër H, et al: Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non–small-cell lung cancer: The phase III randomized ESOGIA-GFPC-GECP 08-02 study. Journal of Clinical Oncology 34:1476-1483, 2016

3Hamaker ME, te Molder M, Thielen N, et al: The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients–A systematic review. Journal of geriatric oncology 9:430-440, 2018

4Mohile SG, Magnuson A, Pandya C, et al: Community oncologists' decision-making for treatment of older patients with cancer. Journal of the National Comprehensive Cancer Network 16:301-309, 2018