Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update

Author:

Dale William1ORCID,Klepin Heidi D.2ORCID,Williams Grant R.3ORCID,Alibhai Shabbir M.H.4ORCID,Bergerot Cristiane5ORCID,Brintzenhofeszoc Karlynn6ORCID,Hopkins Judith O.7,Jhawer Minaxi P.8ORCID,Katheria Vani9ORCID,Loh Kah Poh10ORCID,Lowenstein Lisa M.11ORCID,McKoy June M.12ORCID,Noronha Vanita13ORCID,Phillips Tanyanika14,Rosko Ashley E.15ORCID,Ruegg Tracy16ORCID,Schiaffino Melody K.17,Simmons John F.18ORCID,Subbiah Ishwaria19ORCID,Tew William P.20ORCID,Webb Tracy L.21ORCID,Whitehead Mary22,Somerfield Mark R.23ORCID,Mohile Supriya G.10

Affiliation:

1. City of Hope National Medical Center, Duarte, CA

2. Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC

3. University of Alabama at Birmingham, Birmingham, AL

4. Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

5. CETTRO Cancer Research Hospital in Brasilia, Brazil

6. University of Louisville, Kent School of Social Work, Louisville, KY

7. Novant Health Cancer Institute/SCOR NCORP, Winston-Salem, NC

8. Englewood Health, Englewood, NJ

9. City of Hope Comprehensive Cancer Center, Duarte, CA

10. University of Rochester Medical Center, Rochester, NY

11. University of Texas MD Anderson Cancer Center, Houston, TX

12. Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL

13. TATA Memorial Hospital Mumbai, Mumbai, India

14. Department of Medical Oncology & Therapeutics Research, City of Hope Cancer Center, Duarte, CA

15. Ohio State University Comprehensive Cancer Center, Columbus, OH

16. WellStar School of Nursing, Kennesaw State University, Kennesaw, GA

17. University of California, San Diego Moores Cancer Center, La Jolla, CA

18. SCOREboard, Oakland, CA

19. MD Anderson Cancer Center, Houston, TX

20. Memorial Sloan Kettering Cancer Center, New York, NY

21. Wake Forest University Health Sciences, Winston Salem, NC

22. SCOREboard, Sharon, CT

23. American Society of Clinical Oncology, Alexandria, VA

Abstract

PURPOSE To update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy. METHODS An Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022. RESULTS A total of 26 publications met eligibility criteria and form the evidentiary basis for the update. RECOMMENDATIONS The Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (65+ years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate. The Panel recommends the Practical Geriatric Assessment as one option for this purpose ( https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf ; https://youtu.be/jnaQIjOz2Dw ; https://youtu.be/nZXtwaGh0Z0 ). Additional information is available at www.asco.org/supportive-care-guidelines .

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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