title: Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: a pilot study.
abstract: OBJECTIVE
  A comprehensive geriatric assessment (CGA) is an objective means of assessing the global health of older patients. While evidence suggesting its promise in improving outcome prediction in the oncology setting is growing, its benefit in guiding treatment decisions remains uncertain. We sought to determine the feasibility and impact of CGA, from a consultative geriatric-oncology service, on treatment decisions in older cancer patients.
  
  
  METHODS
  A pilot clinic, where patients underwent CGA with a medical oncologist and geriatrician, was established. Patients ≥70 years, with gastrointestinal or lung cancer were eligible. Following standard assessment by the primary oncologist, a treatment decision was recorded. Patients subsequently underwent a CGA. The final treatment plan was made by the primary oncologist after receipt of findings and recommendations from the CGA. Changes in treatment decisions were recorded.
  
  
  RESULTS
  The study enrolled from January to October 2009. Of 168 eligible patients, 120 (71%) were not referred for assessment. Thirty of 48 patients approached underwent CGA. In six patients the treatment plan was undecided at time of referral. In five of these, CGA impacted the ultimate decision (83%). Where the management plan was decided at time of referral (n=24), CGA impacted the final decision in only 1 patient (4%). Previously unidentified medical problems were identified in 70% of patients.
  
  
  CONCLUSIONS
  Several factors limited the feasibility of a consultation-type geriatric-oncology service to assess older cancer patients. The impact of CGA in informing treatment decisions was modest but may be of value when the initial treatment decision is uncertain.
authors.affiliation: Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Hospital, Toronto, ON, Canada.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Horgan
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Leighl
authors.forename: Linda
authors.initials: L
authors.lastname: Coate
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Liu
authors.forename: Prakruthi
authors.initials: P
authors.lastname: Palepu
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
authors.forename: Nicole
authors.initials: N
authors.lastname: Perera
authors.forename: Marjan
authors.initials: M
authors.lastname: Emami
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008495:Medical Oncology; D009369:Neoplasms / Q000534:rehabilitation* / Q000628:therapy*; D010865:Pilot Projects; D011379:Prognosis; D012017:Referral and Consultation