Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice.
OBJECTIVE
To integrate the principles of geriatric assessment into the care of older patients with cancer in order to identify vulnerable older adults and develop interventions to optimize cancer treatment.


METHODS
A brief, comprehensive, self-administered questionnaire and intervention algorithm were developed consisting of measures of geriatric assessment that are brief, reliable, validated, and predictive of mortality and morbidity in older patients.


METHODS
Academic tertiary care cancer center and community-based satellite practice.


METHODS
Patients aged 65 and older with cancer.


METHODS
The questionnaire solicits information about the patient's functional status, comorbidity, psychological status, nutritional status, and social support. A scoring algorithm for referral to a multidisciplinary team was developed.


RESULTS
Two hundred forty-five of 250 patients completed the questionnaire (mean age 76, range 65-95). The majority of patients were women (71%), white (95%), married (52%), and retired (90%), with a variety of tumor types and stages. Most patients (78%) completed the questionnaire on their own and reported acceptance of questionnaire length (91%), no difficult questions (94%), no upsetting questions (96%), and no missing questions (89%). The mean time to completion was 15 minutes, with a median of 12.5 (standard deviation 10, range 2-60). Information from this questionnaire helped identify physical and psychological impairments, poor nutrition, lack of social support, and untreated comorbidities. Appropriate referrals to a multidisciplinary team were made.


CONCLUSIONS
This brief, comprehensive, self-administered questionnaire is feasible for use in the outpatient oncology setting and helped identify the needs of geriatric oncology patients. Prospective trials are needed to determine the effectiveness of the interventions offered.
Hurria
Arti
A
Division of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California 91010, USA. ahurria@coh.org
Lichtman
Stuart M
SM
Gardes
Jonathan
J
Li
Daneng
D
Limaye
Sewanti
S
Patil
Sujata
S
Zuckerman
Enid
E
Tew
William
W
Hamlin
Paul
P
Abou-Alfa
Ghassan K
GK
Lachs
Mark
M
Kelly
Eva
E
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008495:Medical Oncology; D009369:Neoplasms / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D012944:Social Support; D011795:Surveys and Questionnaires