Arti Hurria and the progress in integrating the geriatric assessment into oncology: Young International Society of Geriatric Oncology review paper

Abstract

Until recently, the progress in the diagnosis and management of cancer has not been matched by similar progress in the assessment of the increasing numbers of older and more complex patients with cancer. Dr. Arti Hurria identified this gap at the outset of her career, which she dedicated toward studying the geriatric assessment (GA) as an improvement over traditional methods used in oncology to assess vulnerability in older patients with cancer. This review documents the progress of the GA and its integration into oncology. First, we detail the GA's origins in the field of geriatrics. Next, we chronicle the early rise of geriatric oncology, highlighting the calls of early thought-leaders to meet the demands of the rapidly aging cancer population. We describe Dr. Hurria's early efforts toward meeting these calls though the implementation of the GA in oncology research. We then summarize some of the seminal studies constituting the evidence base supporting GA's implementation. Finally, we lay out the evolution of cancer-focused guidelines recommending the GA, concluding with future needs to advance the next steps toward more widespread implementation in routine cancer care. Throughout, we describe Dr. Hurria's vision and its execution in driving progress of the GA in oncology, from her fellowship training to her co-authored guidelines recommending GA for all older adults with cancer-published in the year of her untimely death.

Keywords: Arti Hurria; Geriatric assessment; Geriatric oncology; Risk stratification; Supportive care; Vulnerability.

Figure 1:

Core geriatric assessment (GA) domains and their interdependency. Figure based on seminal papers of GA and Dr. Hurria’s early works as cited in this review. See American Society of Clinical Oncology guideline for examples of validated tools to measure each of these domains.

Figure 2:

GA domains and different modalities of their measurement. Data from the geriatric assessment can not only be measured via in-person clinical assessment and patient-reported measures (top left), but can also be measured using administrative and claims data (top right), clinical and remote wearable monitors (bottom left), and remote patient-reported assessments (bottom right).

Figure 3:

Example of measuring GA domains as outcomes affected by cancer and its treatment. This study by Dr. Hurria and colleagues measured physical function at baseline, end of chemotherapy, and 12 months post-chemotherapy—tracking longitudinal change. Reproduced with permission from John Wiley and Sons, Inc., © 2018, Journal of the American Geriatrics Society, Hurria et al., Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer. *12 months post-chemotherapy initiation **Decline: ≥10 point decrease in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) physical function subscale ***Resilience: Return to within 10 points of pre-chemotherapy EORTC physical function subscale result at the 12 month post-chemotherapy initiation timepoint. Only patients with a decline in physical function from pre- to post-chemotherapy were included in the analysis

Figure 4:

Timeline of selected milestones of GA in oncology and selected milestones of Dr. Hurria’s Career. NCI = National Cancer Institute; NIA = National Institute on Aging; SIOG = International Society of Geriatric Oncology; MSK = Memorial Sloan Kettering; GA = Geriatric Assessment; NIH = National Institutes of Health; NCCN = National Comprehensive Cancer Network