Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: American Society of Clinical Oncology Guideline for Geriatric Oncology

By S. Mohile, W. Dale, M. Somerfield, M. Schonberg, C. Boyd, P. Burhenn, B. Canin, H. Cohen, H. Holmes, Judith O. Hopkins and 7 more. Journal of Clinical Oncology, 2018

1,133 citations recorded by the source corpus.

Purpose To provide guidance to clinicians regarding the practical assessment and management of vulnerabilities in older patients undergoing chemotherapy. Methods An Expert Panel was convened to develop clinical practice guideline recommendations based on a systematic review of the medical literature. Results A total of 68 studies met eligibility criteria and form the evidentiary basis for the recommendations. Recommendations In patients ≥ 65 years receiving chemotherapy, geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments. Evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition. The Panel recommends instrumental activities of daily living to assess for function; a thorough history or validated tool to assess comorbidity; a single question for falls; the Geriatric Depression Scale to screen for depression; the Mini-Cog or the Blessed Orientation Memory test to screen for cognitive impairment; and assessment of unintentional weight loss to evaluate nutrition. Either the CARG (Caner and Aging Research Group) or CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) tools are recommended to obtain estimates of chemotherapy toxicity risk; the G8 or Vulnerable Elders Survey-13 can help predict mortality. Clinicians should use one of the validated tools listed at ePrognosis to estimate life expectancy ≥ 4 years. GA results should be applied to develop an integrated and individualized plan that informs treatment selection, and to identify non-oncologic problems amenable to intervention. Collaborating with caregivers is essential to implementing GA-guided interventions. The Panel suggests that clinicians take into account GA results when recommending chemotherapy, and that the information be provided to patients and caregivers to guide treatment decision-making. Clinicians should implement targeted, GA-guided interventions to manage non-oncologic problems. Additional information is available at www.asco.org/vanity-url-guideline and www.asco.org/guidelineswiki.

Subfields: Geriatrics and Gerontology, Oncology, Physiology

View Paper: https://www.semanticscholar.org/paper/401990f1e830a1c4a3fed71df825daeec1f47a4a

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  1. L. Korde
  2. Lisa A. Carey
  3. M. Somerfield
  4. J. Crews
  5. N. Denduluri
  6. S. Loibl
  7. E. Hwang
  8. S. Khan

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