Comprehensive geriatric assessment for patients with cancer
- Arti Hurria, MD
Arti Hurria, MD
- Associate Professor of Medicine
- Director of Cancer and Aging Research Program
- Medical Oncology and Therapeutics Research
- City of Hope
- Harvey Jay Cohen, MD
Harvey Jay Cohen, MD
- Director, Center for the Study of Aging
- Walter Kempner Professor of Medicine
- Chair Emeritus, Department of Medicine
- Duke University
- Section Editors
- Reed E Drews, MD
Reed E Drews, MD
- Section Editor — Complications of Cancer
- Associate Professor of Medicine
- Harvard Medical School
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Approximately 60 percent of new cases and 70 percent of mortality from cancer occur in patients ≥65 years of age . As a result, the care of older patients constitutes an important part of the everyday practice for the adult oncologist.
Despite the high incidence of cancer in this group, older patients have been underrepresented in clinical trials that set the standards for care in oncology practice [2-4]. Less data exist regarding the risks and benefits of cancer treatment in this population, and there are few guidelines that specifically address the evaluation and treatment of the older patient.
Older patients are less likely to receive all types of standard cancer therapies compared to younger individuals [5-12]. Possible reasons include concerns regarding increased toxicity, competing causes of morbidity and mortality, lack of access to care, and physician or patient preference.
Chronologic age alone provides relatively little information regarding an individual's tolerance to cancer treatment. Among patients of the same age, there is wide heterogeneity in the ability to undergo aggressive therapy.
Identifiable comorbid conditions and organ-specific physiologic changes due to aging can limit a patient's ability to tolerate cancer therapy. In addition, the aging process can be associated with decreased physiologic reserve affecting multiple systems. This can be manifested as frailty and can interfere with the functional status of the patient, even in the absence of specific comorbidities. The manifestations of frailty include various components of weight loss, exhaustion, weakness, relative immobility, and a general decrease in physical activity.
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- POTENTIAL BENEFITS
- Who needs a CGA?
- Pre-CGA screening tools
- DOMAINS OF A CGA
- Functional status
- Cognitive function
- Psychological state and social support
- Medication review
- OBTAINING PATIENT DATA
- Mailed CGA
- Self-administered CGA
- Clinical interview
- USE OF CGA RESULTS
- SUMMARY AND RECOMMENDATIONS