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ASCO guidelines for geriatric assessment-guided interventions in patients with cancer

ASCO guidelines for geriatric assessment-guided interventions in patients with cancer
Geriatric assessment measure Geriatric assessment: Guided interventions
Function and falls
  • Instrumental activities of daily living deficit
  • History of falls
  • Physical therapy and/or occupational therapy referrals to prescribe strength and balance training, assist device evaluation, home exercise program, and safety evaluation
  • Fall prevention discussion
  • Home safety evaluation
Comorbidity domain
  • Comorbidity and polypharmacy considerations
  • Involve caregiver in discussions to assess risks of therapy and management of comorbidities
  • Involve primary care physician and/or geriatrician in decision making for treatment and management of comorbidities; consider referral to geriatrician
  • Review medication list and minimize medications as much as possible; consider involving a pharmacist
  • Assess adherence to medications; have patient bring in medications to review
Cognition
  • Screen positive on validated cognitive screen
  • Assess decision-making capacity and ability to consent for treatment
  • Identification of health care proxy and involve proxy in decision making for treatment, including signing consent forms with patient
  • Delirium risk counseling for patient and family
  • Medication review to minimize medications with higher risk of delirium
  • Consider further workup with geriatrician or cognitive specialist
Depression
  • Geriatric Depression Scale >5
  • Consider referral for psychotherapy/psychiatry
  • Consider cognitive-behavioral therapy
  • Social work involvement
  • Consider pharmacologic therapy
Nutrition
  • Weight loss >10%
  • Nutrition counseling
  • Referral to nutritionist/dietician
  • Assess need for extra support for meal preparation and institute support interventions if necessary (eg, caregiver, Meals on Wheels)
ASCO: American Society of Clinical Oncology.
Reprinted with permission from: Mohile SG, Dale W, Somerfield MR, et al. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol 2018; 36:2326. Copyright © 2018 American Society of Clinical Oncology. All rights reserved.
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