Esther G. Chong discusses geriatric assessment in cancer treatment

Chronological age alone fails to predict how an older patient will tolerate cancer treatment, according to a presentation at the Community Oncology Global Congress, Oncodaily reported. Esther G. Chong, a medical oncologist and assistant professor at the OHSU Knight Cancer Institute, addressed the question at the conference organized by OncoDaily.

Approximately 60 percent of new cancer diagnoses occur in adults aged 65 and older, and about 70 percent of cancer deaths happen in the same age group. Despite these figures, only about 20 percent of U.S. oncology clinicians report performing a geriatric assessment most or all of the time.

Comparing Two Patients at Age 78

To illustrate the limitations of chronological age, the presentation examined two hypothetical patients, both aged 78 and classified as ECOG performance status 0 to 1. Patient 1 is independent in activities of daily living, has no significant unmanaged comorbidities, experiences no major cognitive or mood concerns, has strong social support, is well nourished, and faces no major polypharmacy issues. This patient may tolerate systemic therapy relatively well, though age alone should still not dictate the decision.

Patient 2 requires help with instrumental activities such as finances, medications, or transportation, carries multiple uncontrolled comorbidities, has mild cognitive impairment apparent to close family members, lives alone with limited caregiver support, and takes five or more medications daily. This patient requires a closer evaluation of function, cognition, comorbidities, social support, and medication burden before clinicians select a treatment.

Screening and Assessment Tools for Older Adults

Traditional performance measures like the ECOG Performance Status and Karnofsky Performance Status remain familiar and quick to calculate, but they were validated largely in younger populations. I would argue to say that performance status should be like a biomarker. It is both predictive and prognostic, Chong stated during the presentation.

To capture vulnerabilities more accurately, the NCCN Older Adult Oncology Guidelines framework outlines a stepwise approach. Patients aged 65 and older can first undergo a brief screening test such as the G8 or the Vulnerable Elders Survey-13.

The G8 takes approximately five minutes or less and assesses eight items, including appetite, weight loss, mobility, neuropsychological concerns, and comorbidities. The VES-13 contains 13 items covering age, activity independence, self-rated health, difficulty with physical tasks, and the need for assistance with daily activities. A positive result on either screening tool indicates that a patient should proceed to a comprehensive geriatric assessment.

Predicting Chemotherapy Toxicity Risks

When considering aggressive chemotherapy, validated toxicity calculators help make risk discussions more objective for older adults. The Cancer and Aging Research Group toxicity score estimates the likelihood of grade 3 or higher chemotherapy toxicity in adults aged 65 and older.

Similarly, the Chemotherapy Risk Assessment Scale for High-Age Patients estimates the risk of serious toxicity before treatment begins. The CARG-BC tool further refines toxicity prediction specifically for older patients with early breast cancer considering adjuvant chemotherapy.

Multidisciplinary Interventions After Assessment

Randomized trials show that geriatric assessment-directed interventions can reduce treatment-related toxicity and premature discontinuation while helping preserve quality of life and independence.