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. 2023 Sep 10;41(26):4293-4312.
doi: 10.1200/JCO.23.00933. Epub 2023 Jul 17.

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

William Dale  1 , Heidi D Klepin  2 , Grant R Williams  3 , Shabbir M H Alibhai  4 , Cristiane Bergerot  5 , Karlynn Brintzenhofeszoc  6 , Judith O Hopkins  7 , Minaxi P Jhawer  8 , Vani Katheria  9 , Kah Poh Loh  10 , Lisa M Lowenstein  11 , June M McKoy  12 , Vanita Noronha  13 , Tanyanika Phillips  14 , Ashley E Rosko  15 , Tracy Ruegg  16 , Melody K Schiaffino  17 , John F Simmons Jr  18 , Ishwaria Subbiah  19 , William P Tew  20 , Tracy L Webb  21 , Mary Whitehead  22 , Mark R Somerfield  23 , Supriya G Mohile  10
Affiliations

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

William Dale et al. J Clin Oncol. .

Erratum in

Abstract

Purpose: To update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy.

Methods: An Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022.

Results: A total of 26 publications met eligibility criteria and form the evidentiary basis for the update.

Recommendations: The Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (65+ years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate.The Panel recommends the Practical Geriatric Assessment as one option for this purpose (https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf; https://youtu.be/jnaQIjOz2Dw; https://youtu.be/nZXtwaGh0Z0).Additional information is available at www.asco.org/supportive-care-guidelines.

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Conflict of interest statement

The Expert Panel was assembled in accordance with ASCO’s Conflict of Interest Policy Implementation for Clinical Practice Guidelines (“Policy,” found at https://www.asco.org/guideline-methodology). All members of the Expert Panel completed ASCO’s disclosure form, which requires disclosure of financial and other interests, including relationships with commercial entities that are reasonably likely to experience direct regulatory or commercial impact as a result of promulgation of the guideline. Categories for disclosure include employment; leadership; stock or other ownership; honoraria, consulting or advisory role; speaker’s bureau; research funding; patents, royalties, other intellectual property; expert testimony; travel, accommodations, expenses; and other relationships. In accordance with the Policy, the majority of the members of the Expert Panel did not disclose any relationships constituting a conflict under the Policy.

AUTHORS DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

ASCO/JCO re-checks prior to final submission

William Dale

References

    1. Mohile SG, Dale W, Somerfield MR, et al. : Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol 36:2326–2347, 2018 - PMC - PubMed
    1. Shojania KG, Sampson M, Ansari MT, et al. : How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med 147:224–33, 2007 - PubMed
    1. Mohile SG, Mohamed MR, Xu H, et al. : Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet 398:1894–1904, 2021 - PMC - PubMed
    1. Li D, Sun CL, Kim H, et al. : Geriatric Assessment-Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer: A Randomized Clinical Trial. JAMA Oncol 7:e214158, 2021 - PMC - PubMed
    1. Dale W, Williams GR, A RM, et al. : 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. JCO Oncol Pract 17:336–344, 2021 - PMC - PubMed

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