Geriatric assessment (GA) of older patients with cancer in Australia: A national, multicenter audit.

Abstract

9134 Background: It is recommended that all older patients presenting for oncology opinion undergo a geriatric assessment. This may guide intervention, alert clinicians to problems and predict treatment toxicity and outcome. The rate of geriatric assessment in Australia is unknown. Methods: This is a multicentre audit in 2 parts: a retrospective file review and prospective audit of case presentations at multidisciplinary meetings (MDMs). Patients aged over 70 years presenting to a medical oncology clinic or being discussed at an MDM were eligible. Documentation of initial consultation with an oncologist was reviewed. Any mention of a GA domain was noted. These domains included: Activities of Daily Living (ADLs), Instrumental ADLs (IADLs), geriatric syndromes (eg cognitive impairment, falls), social support, polypharmacy and creatinine clearance (CrCl). Data was collected at six oncology centres in Victoria, NSW and Canberra (ACT). Results: Data was collected from 251 file reviews and 108 MDM discussions in a total of 304 patients. Median age 76 years (range 70-95). Treatment was proposed in 72% of file reviews and 80% of MDMs. Factors known to affect outcome like performance status (PS) (62%), comorbidities (98%), living alone or with someone (88%) and social support (73%) were most frequently assessed at initial consult with an oncologist. Other domains like mention of any ADL (56%), IADL (36%), geriatric syndrome (30%), CrCl (17%) and polypharmacy (30%) were not as frequently assessed. A formal comorbidity score (eg Charlson index) was never used. Only 1 patient had all components of ADLs and IADLs assessed. Treatment was withheld on the basis of age alone in 5 patients. GA domains mentioned at MDMs were comorbidities (84%), living alone/with someone (30%), social support (24%), ADLs (23%), PS (19%), polypharmacy (13%), geriatric syndromes (10%), IADL (6%) and creatinine clearance (3%). Conclusions: This multicentre audit of Australian medical oncology practice is the first documentation of the rate of routine GA in patients aged over 70 years. There is significant room for improvement. Education regarding the importance and utility of routine GA may improve the assessment of some GA domains.