title: Geriatric assessment in surgical oncology: a systematic review.
abstract: BACKGROUND
  The comprehensive geriatric assessment (CGA) has developed as an important prognostic tool to risk stratify older adults and has recently been applied to the surgical field. In this systematic review, we examined the utility of CGA components as predictors of adverse outcomes among geriatric patients undergoing major oncologic surgery.
  
  
  METHODS
  MEDLINE, Embase, and the Cochrane Library were searched for prospective studies examining the association of components of the CGA with specific outcomes among geriatric patients undergoing elective oncologic surgery. Outcome parameters included 30-d postoperative complications (POC), mortality, and discharge to a nonhome institution.
  
  
  RESULTS
  The initial search identified 178 potentially relevant articles, with six studies meeting inclusion criteria. Deficiencies in instrumental activities of daily living, activities of daily living, fatigue, cognition, frailty, and cognitive impairment were associated with increased POC. No CGA predictors were identified for postoperative mortality whereas frailty, deficiencies in instrumental activities of daily living, and depression predicted discharge to a nonhome institution.
  
  
  CONCLUSIONS
  Across a variety of surgical oncologic populations and cancer types, components of the CGA appear to be predictive of POC and discharge to a nonhome institution. These results argue for inclusion of focused geriatric assessments as part of routine preoperative care in the geriatric surgical oncology population.
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; The Ohio State College of Medicine, Columbus, Ohio.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Feng
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: McMillan
authors.affiliation: Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Karen
authors.initials: K
authors.lastname: Crowell
authors.affiliation: Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Geriatric Oncology, Chapel Hill, North Carolina; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Hyman
authors.initials: H
authors.lastname: Muss
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Geriatric Oncology, Chapel Hill, North Carolina; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Geriatric Oncology, Chapel Hill, North Carolina; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: angela_smith@med.unc.edu.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
mesh_terms: D000368:Aged; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000401:mortality* / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies
keywords: Cancer surgery; Complication; Geriatric assessment; Survival; Treatment outcome
references.citation: Am J Surg. 2012 Aug;204(2):139-43
references.pmid: 22178483
references.citation: Ann Surg. 2009 Sep;250(3):449-55
references.pmid: 19730176
references.citation: Crit Rev Oncol Hematol. 2008 Feb;65(2):156-63
references.pmid: 18082416
references.citation: Crit Rev Oncol Hematol. 2005 Sep;55(3):241-52
references.pmid: 16084735
references.citation: Chest. 2005 Mar;127(3):886-91
references.pmid: 15764772
references.citation: J Surg Oncol. 2013 Sep;108(3):182-6
references.pmid: 23804149
references.citation: Crit Rev Oncol Hematol. 2005 May;54(2):129-36
references.pmid: 15843095
references.citation: J Am Coll Surg. 2010 Jun;210(6):901-8
references.pmid: 20510798
references.citation: J Surg Res. 2011 Mar;166(1):5-13
references.pmid: 20828735
references.citation: Circulation. 2010 Mar 2;121(8):973-8
references.pmid: 20159833
references.citation: Crit Rev Oncol Hematol. 2010 Dec;76(3):208-17
references.pmid: 20005123
references.citation: J Clin Oncol. 2011 Apr 1;29(10):1290-6
references.pmid: 21357782
references.citation: J Am Coll Surg. 2012 Oct;215(4):453-66
references.pmid: 22917646