The impact of comprehensive geriatric assessment on final treatment decisions

Abstract

Introduction: Comprehensive geriatric assessment (CGA) is the predominantly used tool to identify geriatric problems in elderly patients with cancer (1,2). There is increasing evidence that CGA can predict toxicity and mortality (3–5). If the results of a CGA affect clinical decision making of oncologists is less clear. Objectives: The aim of this studywas to determine the impact of CGA on treatment decisions prior to systemic therapy in elderly patients with cancer. Methods: A review of the literature was performed including studies published until the 27th of January 2014 using search terms including Neoplasm, Aged, Geriatric Assessment. Results: The impact of CGA on treatment decisions has sparsely been studied and none of these studies were randomized controlled trials (1,3,6). A meta-analysis performed in 2012, combined 6 studies on the impact of CGA on treatment decision making. The weighted percent modification was 23% (3). A study published in 2013 by Kenis et al. showed an impact of the CGA on treatment decision in 282 of 1115 patients (25%) (2). Another recent French retrospective study showed that CGA impacted final cancer treatment decision in 19 of 107 (18%) frail heterogenous cancer patients (6) (Table 1). Image: Conclusion: Impact of CGA on final treatment decision varies between 18 and 25%. So far, no clinical studies have demonstrated that CGA based treatment changes do improve treatment outcome or quality of life in patients with cancer due to lack of follow-up. Research is needed to determine the timing and the content of the assessment modifying clinical decision making by oncologists (7). Outcome measure should include objectively measured outcome, such as physical activity, patient reported outcome measures and classical endpoints like overall survival.