PCN244 DISPARITIES IN CANCER CARE: THE UNMET NEED FOR GERIATRIC PATIENTS

Abstract

Cancer disparities are often discussed in context of race/ethnicity, gender/sexual identity, income, geography, and disability. Older patients represent the largest cancer demographic yet have worse outcomes. Older patients may be under-treated due to concerns for toxicity or may suffer excessive toxicity from standard treatments intended for younger, healthier patients who disproportionately accrue to clinical trials. Validated geriatric assessment tools (GA) have been found to improve clinical outcomes. We sought to evaluate knowledge and practices regarding geriatric cancer patients. Live meetings in Fall 2019 convened a total of 169 community hematologists/oncologists (cH/O) of broad US geography and practice types. Participants submitted responses via a web-based survey before the meeting and via an audience response system at the live meeting. Half the cH/O reported that 26-50% of their cancer patients were age ≥70; while 24% reported that >50% were age ≥70. Most (58%) performed no formal GA to inform treatment decisions. The two most common reasons for not performing GAs were that it was too cumbersome to incorporate into routine practice (47%), and that it adds no value beyond the comprehensive history and physical exam (38%). For cancer patients age ≥75, ECOG performance status and comorbidity were the two factors considered most by oncologists when making treatment decisions (88% and 73%, respectively). The Mini-Mental State Exam (63%) and Comprehensive GA (37%) were the tools most cH/O were aware of (63%); with 22% not aware of any GA tools. Older patients comprise a large proportion of the oncology patients treated by US-based cH/O, yet the majority of cH/O surveyed do not perform any GA. Research is warranted to determine what resources/efforts are needed to increase GA use in clinical practice.