Use of Geriatric Screening Tools to Assess Older Patients With Cancer

For many clinicians working in oncology today, most of their patients are likely to be older.  As for most types of cancer, the risk of developing cancer increases with age. Currently, the median age at diagnosis of any cancer is 66 years in the United States, with slight differences for each type of cancer.¹ 

The older population of patients often have other medical comorbidities that contribute to their overall health, as well as other challenges due to their age.² Chronological age is not necessarily an accurate indicator of a patient’s ability to tolerate chemotherapy, and cancer treatment is not one-size-fits-all. Age is just one factor to consider with treatment planning. Performing a comprehensive geriatric assessment (CGA) prior to and after treatment can be an effective way to monitor the older patient. A recently published observational study evaluated the use of a standardized geriatric assessment, the Geriatric 8 (G8), as well as CGA to determine how these tools could be used to evaluate functional status and quality of life before and after chemotherapy.³ 

Comprehensive Geriatric Assessment

The CGA is not one standardized test administered to patients. It is generally made up of multiple tests and evaluations that assess different factors for each person. Low scores in these areas have been associated prognostically with decreased survival. As it is comprehensive, CGA may take a significant amount of time to adequately perform a thorough evaluation for every patient. The following are systems that are reviewed during a CGA.⁴ 

Comorbidities Various comorbid conditions can potentially affect how one will deal with the prescribed cancer therapy. Certain conditions may be more likely to lead to increased toxicity from treatment or may potentiate the need to have to eliminate certain treatments altogether. 

Polypharmacy When elderly patients use multiple medications, this puts them at risk for potential interactions between medications and increases their risk for toxicity. Polypharmacy is typically defined as the use of at least 5 daily medications. 

Psychosocial function The presence of preexisting depression can impact how well a patient with cancer reacts to their diagnosis and adheres to the prescribed treatment plan. The Geriatric Depression scale can be used to determine depression score.  

Cognitive function The Mini Mental State test is used to screen for cognitive function. This can help alert the oncology team to difficulties with cognition and memory that may contribute to a patient’s nonadherence to their treatment plan. 

Functional status Assessing functional status can evaluate not only the activities of daily living (ADL), such as feeding, dressing, and toileting, but also instrumental activities of daily living (IADL). IADL assesses the ability to perform tasks to live independently, such as preparing meals, doing laundry, housekeeping, and managing finances. 

Nutritional status Malnutrition and nutritional deficiencies can be common among the elderly. The Mini Nutritional Assessment (MNA) can be used to determine those who are deficient or are at risk.