Comprehensive Geriatric Assessments Key to Treatment Planning in Elderly Patients


Comprehensive geriatric assessments will play an increasingly important role in identifying patient frailty and personalizing geriatric oncology treatment, according to recently published reviews.

Comprehensive geriatric assessment (CGAs) will play an increasingly important role in identifying patient frailty and personalizing geriatric oncology treatment, according to several recently published reviews.[1-3]

CGAs measure baseline patient cognitive function, nutritional status, and physical functional status.[1,2] Both cancer and its treatment can profoundly stress organ and immunologic function in older adults.

“CGA predicts survival in colorectal cancer, identifies high-risk surgical oncology patients, predicts toxicities associated with breast cancer treatment, helps determine cancer treatment decisions, and identifies those individuals who are most likely to tolerate cancer treatment,” reported authors of a review in Seminars in Oncology Nursing.[3]

But the concept of frailty in geriatric oncology is a deceptively simple one, cautioned researchers at Emory University’s Winship Cancer Institute in Atlanta.[1]

“Put simply, frailty is a state of extreme vulnerability to stressors that leads to adverse health outcomes,” wrote Cecilia G. Ethun, MD, and coauthors.[1] “In reality, frailty is a complex, multidimensional, and cyclical state of diminished physiologic reserve that results in decreased resiliency and adaptive capacity and increased vulnerability to stressors.”

More than 70 CGA instruments have been proposed.[1] Better standardization is needed for cut-off score thresholds to identify frailty, the authors concluded.[1]

As the Baby Boomer generation ages and enters high-risk years for cancer diagnosis, oncology nurses will conduct CGAs to inform multidisciplinary clinical geriatric oncology decision-making.[3]

“Objective findings from the CGA can be crucial in developing end-of-life care plans that reflect both the patient’s health status and personal values,” noted authors of another review, published online ahead of print in Current Oncology Reports.[2] CGA can help inform patients about realistic treatment outcomes and spare frail patients toxic side effects from treatments that are unlikely to effectively control their tumors.[2]

Authors of a systematic review of 36 published studies, including 27 prospective studies, concluded that CGA predicts which elderly patients are likely to benefit from chemotherapy and which will suffer adverse events.[4]

Other recently published studies have bolstered the case that frailty predicts worse treatment outcomes.[3] A study of 535 women with advanced ovarian cancer, published in the October issue of Gynecologic Oncology, found that frailty was an independent predictor of postsurgical mortality even after statistically controlling for other known risk factors; overall survival (OS) was significantly shorter among frail patients than non-frail patients (median OS: 26.5 months vs 44.9 months; P < .001).[5]

“Routine assessments of frailty can be incorporated into patient counseling and decision-making for the advanced epithelial ovarian cancer patient beyond simple reliance on single factors such as age,” the authors of the ovarian surgery outcomes study concluded.[5]


1. Ethun CG, Bilen MA, Jani AB, et al. Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA Cancer J Clin. 2017;67:362-77.

2. Baronner A, MacKenzie A. Using geriatric assessment strategies to lead end-of-life care discussions. Curr Oncol Rep. 2017;19:75.

3. Overcash J, Momeyer MA. Comprehensive geriatric assessment and caring for the older person with cancer. Semin Oncol Nurs. 2017 Sep 15. [Epub ahead of print]

4. Janssens K, Specenier P. The prognostic value of the comprehensive geriatric assessment (CGA) in elderly cancer patients (ECP) treated with chemotherapy (CT): a systematic review. Eur J Cancer. 2017;72(suppl 1):S164-5.

5. Kumar A, Langstraat CL, DeJong SR, et al. Functional not chronologic age: Frailty index predicts outcomes in advanced ovarian cancer. Gynecol Oncol. 2017;147:104-9.

Related Videos
Developing novel regimens may continue to improve survival outcomes of patients with advanced cervical cancer following the FDA approval of pembrolizumab and chemoradiation, says Jyoti S. Mayadev, MD.
Treatment with pembrolizumab plus chemoradiation appears to be well tolerated with no detriment to quality of life among those with advanced cervical cancer.
Jyoti S. Mayadev, MD, says that pembrolizumab in combination with chemoradiation will be seamlessly incorporated into her institution’s treatment of those with FIGO 2014 stage III to IVA cervical cancer following the regimen’s FDA approval.
Domenica Lorusso, MD, PhD, says that paying attention to the quality of chemoradiotherapy is imperative to feeling confident about the potential addition of pembrolizumab for locally advanced cervical cancer.
Guidelines from the Society of Gynecologic Oncology may help with managing the ongoing chemotherapy shortage in the treatment of patients with gynecologic cancers, according to Brian Slomovitz, MD, MS, FACOG.
Interim data reveal favorable responses in patients with low-grade serous ovarian cancer treated with avutometinib plus defactinib, according to Susana N. Banerjee, MD.
Brian Slomovitz, MD, MS, FACOG, notes that sometimes there is a need to substitute cisplatin for carboplatin, and vice versa, to best manage gynecologic cancers during the chemotherapy shortage.
Findings from the phase 3 MIRASOL trial support mirvetuximab soravtansine as a standard treatment option for platinum-resistant ovarian cancer, according to Ritu Salani, MD.
Trastuzumab deruxtecan appears to elicit ‘impressive’ responses among patients with HER2-positive gynecologic cancers regardless of immunohistochemistry in the phase 2 DESTINY-PanTumor02 trial.
Ritu Salani, MD, highlights the possible benefit of a novel targeted therapy and autologous tumor vaccine in patients with platinum-resistant ovarian cancer, and in the maintenance setting after treatment for platinum-sensitive disease.
Related Content