The effect of comprehensive geriatric assessment on care received, treatment completion, toxicity, cancer-related and geriatric assessment outcomes, and quality of life for older adults receiving systemic anti-cancer treatment: A systematic review

Domenica Disalvo; Erin Moth; Wee Kheng Soo; Maja V Garcia; Prunella Blinman; Christopher Steer; Ingrid Amgarth-Duff; Jack Power; Jane Phillips; Meera Agar

doi:10.1016/j.jgo.2023.101585

The effect of comprehensive geriatric assessment on care received, treatment completion, toxicity, cancer-related and geriatric assessment outcomes, and quality of life for older adults receiving systemic anti-cancer treatment: A systematic review

J Geriatr Oncol. 2023 Nov;14(8):101585. doi: 10.1016/j.jgo.2023.101585. Epub 2023 Aug 10.

Authors

Affiliations

¹ Improving Palliative, Aged and Chronic Care, through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia. Electronic address: domenica.disalvo@uts.edu.au.
² Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Macquarie University Hospital, Macquarie University, Sydney NSW, Australia.
³ Eastern Health Clinical School, Monash University, Victoria, Australia; Cancer Services, Eastern Health, Victoria, Australia; Department of Aged Medicine, Eastern Health, Victoria, Australia.
⁴ Improving Palliative, Aged and Chronic Care, through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
⁵ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia.
⁶ Border Medical Oncology, Albury, NSW, Australia.
⁷ School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.

PMID: 37573197
DOI: 10.1016/j.jgo.2023.101585

Abstract

Introduction: This systematic review aims to summarise the available literature on the effect of geriatric assessment (multidimensional health assessment across medical, social, and functional domains; "GA") or comprehensive geriatric assessment (geriatric assessment with intervention or management recommendations; "CGA") compared to usual care for older adults with cancer on care received, treatment completion, adverse treatment effects, survival and health-related quality of life.

Materials and methods: A systematic search of MEDLINE, EMBASE, CINAHL, and PubMed was conducted to identify randomised controlled trials or prospective cohort comparison studies on the effect of GA/CGA on care received, treatment, and cancer outcomes for older adults with cancer.

Results: Ten studies were included: seven randomised controlled trials (RCTs), two phase II randomised pilot studies, and one prospective cohort comparison study. All studies included older adults receiving systemic therapy, mostly chemotherapy, for mixed cancer types (eight studies), colorectal cancer (one study), and non-small cell lung cancer (one study). Integrating GA/CGA into oncological care increased treatment completion (three of nine studies), reduced grade 3+ chemotherapy toxicity (two of five studies), and improved quality of life scores (four of five studies). No studies found significant differences in survival between GA/CGA and usual care. GA/CGA incorporated into care decisions prompted less intensive treatment and greater non-oncological interventions, including supportive care strategies.

Discussion: GA/CGA integrated into the care of an older adult with cancer has the potential to optimise care decisions, which may lead to reduced treatment toxicity, increased treatment completion, and improved health-related quality of life scores.

Keywords: Comprehensive geriatric assessment; Geriatric oncology; Older adults; Supportive care; Systemic anticancer therapy; Toxicity.

Publication types

Systematic Review
Review

MeSH terms

Aged
Carcinoma, Non-Small-Cell Lung*
Geriatric Assessment / methods
Humans
Lung Neoplasms*
Medical Oncology
Neoplasms* / drug therapy
Quality of Life