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A Practical Approach to Geriatric Assessment in Oncology

Miriam B. Rodin, Supriya G. Mohile

From the Department of Medicine, University of Chicago, Chicago, IL; and the Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY

Address reprint requests to Miriam B. Rodin, MD, PhD, The University of Chicago, MC 6098, 5849 S Maryland W-700, Chicago, IL 60637; e-mail: mrodin{at}medicine.bsd.uchicago.edu

More than half of new cancers are diagnosed in elderly patients, but data from randomized clinical trials do not represent the elderly population. Comprehensive geriatric assessment (CGA) can contribute valuable information to oncologists for risk stratification of elderly cancer patients. Functional impairments, frailty markers, cognitive impairments, and physical disabilities increase the risk for adverse outcomes during cancer treatment. Evidence is accumulating that selected elderly cancer patients benefit from CGA and geriatric interventions. However, perceived barriers to CGA include time, familiarity, cost, and lack of a well-defined procedure to interpret and apply the information. We present a model for rapid selection of elderly who would benefit from CGA using screening tools such as the Vulnerable Elders-13 Survey. We also define important geriatric functional risk factors, including mobility limitation, frailty, and dementia, and demonstrate how brief screening tests can make use of data realistically available to clinical oncologists to determine a stage of aging. Summary tables and a decision tree demonstrate how these data can be compiled to determine the risk for toxicities and to anticipate ancillary support needs.

Supported by the American Society of Clinical Oncology (ASCO) -Hartford Fellowship Training Program in Geriatric Oncology (M.B.R.), the ASCO Young Investigator Award (S.G.M.), Hartford Centers of Excellence (S.G.M.), the University of Chicago Cancer Research Center Women's Board (M.B.R.), the Illinois Department of Public Health Penny Severns Breast Cancer Research Fund (M.B.R.).

Presented in part in lecture format at the University of Chicago Section of Oncology Fellows' Intensive course, Chicago, IL, July 25, 2006; the University of Louisville, Department of Medicine, Louisville, KY, September 5, 2005; St Louis University Geriatrics Grand Rounds, St Louis, MO, October 9, 2004; and the University of Chicago Conference on Geriatric Oncology, Chicago, IL, October 5, 2002.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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