Oncologists’ perceptions of the need for assessing individual domains in the geriatric assessment and worthwhile outcomes in treating older patients with cancer

Abstract

Background: Although the multidimensional geriatric assessment (GA) is considered the standard of care, it is not uniformly practiced. In older patients with cancer, shared decision-making requires a clear understanding of the goals of therapy. Objectives: We aimed to understand the perceptions of health-care professionals of the need to assess the various domains in the GA and what would constitute worthwhile outcomes in older patients with cancer. Materials and Methods: An online questionnaire survey was conducted by the geriatric oncology group of the Department of Medical Oncology at the Tata Memorial Hospital in Mumbai, India. Participants in the survey included various health professionals with an interest in the care of older patients with cancer. Data were collected in Microsoft Excel and basic descriptive statistics were performed. Results: Between July and August 2020, 234 health-care professionals responded to the survey. The respondents included predominantly medical oncologists (146, 70.9%), practicing in academic centers (148, 65.6%) from India (168, 87%). According to 46% of the respondents, over 30% of the patients in their practices were in the geriatric age group; yet, 144 (73.8%) respondents reported that they referred <10% of their older patients with cancer for a GA. Almost all the respondents agreed that it was important to check for the presence of polypharmacy, inappropriate medications, comorbidities, drug interactions, falls, function, psychological status, cognition, nutrition, social support, and quality of life in the older patients with cancer. Over 95% of the respondents thought that formal training in the GA should be part of the oncology training programs. According to 139 respondents (63%), an improvement in the quality of life or a decrease in toxicity were more important goals of cancer-directed therapy in older patients with cancer, compared to prolongation of overall survival. Conclusion: There is a recognition of the importance of performing a multidimensional GA in older patients with cancer; however, this has not translated into a widespread performance of the GA in actual practice. It would be important to address the barriers to implementing the GA in the clinic, to help optimize the care of older patients with cancer. The goals of cancer-directed therapy should be clearly discussed with the patients in order for true shared decision-making to occur.