ASCO Updates Guideline for Assessment, Management of Vulnerabilities in Older Patients Undergoing Chemo

05/23/18

The American Society of Clinical Oncology (ASCO) released an update to their guideline for geriatric oncology, focused on the practical assessment and management of vulnerabilities in older patients receiving chemotherapy.

An expert panel was convened to develop clinical practice guideline recommendations based on a systematic review of the available literature. A total of 68 studies met the eligibility criteria and were utilized to help form these recommendations:

  • In patients aged 65 years or older receiving chemotherapy, geriatric assessment—the evaluation of functional status, physical performance and falls, comorbid medical conditions, depression, social activity/support, nutritional status, and cognition—should be used to identify vulnerabilities or geriatric impairments that are not routinely captured in oncology assessments.
  • In patients aged 65 years or older receiving chemotherapy, validated and practical geriatric assessment-based tools can be used to predict adverse outcomes. Details of the recommended tools can be found in the full guideline update (published online in the Journal of Clinical Oncology; May 21, 2018; doi:10.1200/JCO.2018.78.8687).
  • Clinicians should use either the Schonberg or Lee Index to estimate life expectancy of 4 years.
  • Clinicians should apply the results of the geriatric assessment to develop an integrated and individualized plan for patients that informs treatment selection by helping estimate risk for adverse outcomes and to identify non-oncologic problems that may be amenable to intervention.
  • Clinicians should take into account the information provided to patients and caregivers to guide decision making for treatment. In addition, clinicians should implement targeted, geriatric assessment-guided interventions to manage non-oncologic problems.

The panel also stressed that cancer clinical trials are vital to inform medical decisions for older patients with cancer and improve cancer care. “All older patients should have the opportunity to participate in clinical trials,” the guideline states.—Zachary Bessette