How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology

Abstract

Purpose: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers' practices using GA. Therefore, ASCO's Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA.

Methods: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO's Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05.

Results: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%).

Conclusion: Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.

Fig 1.

Summary of differences between those who are aware of the ASCO Geriatric Oncology Guideline and those who are not.

Fig 2.

Use of validated tools to assess domains in older adults with cancer, comparing those aware of ASCO guidelines with those who are not: percentage responding “yes” to each domain. P < .001 for all domains.

Fig 3.

Geriatric assessment domains assessed with specific tools, comparing those aware of ASCO guidelines with those who are not: percentage responding “always” or “most of the time.” (A) Before initiating chemotherapy. P < .001 for all domains except nutritional status (P = .0011). (B) After initiating chemotherapy. P < .001 for functional status, social activity, and cognition; P = .0011 for physical performance; P = .0015 for nutritional status.

Fig 4.

Barriers to performing geriatric assessments, comparing those aware of ASCO guidelines with those not aware: percentage responding “strongly agree” or “agree.” P < .001 for lack of time, lack of reimbursement, lack of training/knowledge, lack of awareness of tools, and uncertainty of which tool to use; P = .002 for lack of support staff; P =.014 for limited availability of space; P =.796 for lack of available resources for referrals; P =.452 for limited evidence to support use in practice.