Comprehensive geriatric assessment in oncology

Abstract

The incidence of cancer increases with advanced age and the majority of cancer deaths are in patients aged ≥ 65. The geriatric population is a heterogeneous group and a patient's chronologic age does not always correlate with underlying physiologic status. Oncologists need to be able to obtain information on physiologic and functional capacity in older patients in order to provide safe and effective treatment recommendations. The Comprehensive Geriatric Assessment (CGA) is a compilation of validated tools that predict morbidity and mortality in community-dwelling older adults. The various components of the CGA have also been shown to influence clinical decision-making and predict outcomes in older cancer patients. The combined data from the CGA can be used to stratify patients into risk categories to better predict their tolerance to treatment and risk for chemotherapy toxicity. However, the CGA is a comprehensive tool requiring significant time and training to perform. A variety of screening tools have been developed which may be useful in the general oncology practice setting to identify patients that may benefit from further testing and intervention. This chapter will review the components and predictive value of CGA in older cancer patients, with emphasis on how CGA can practically be incorporated into clinical practice.