TY - JOUR
T1 - Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy
T2 - ASCO Guideline Update
AU - Dale, William
AU - Klepin, Heidi D.
AU - Williams, Grant R.
AU - Alibhai, Shabbir M.H.
AU - Bergerot, Cristiane
AU - Brintzenhofeszoc, Karlynn
AU - Hopkins, Judith O.
AU - Jhawer, Minaxi P.
AU - Katheria, Vani
AU - Loh, Kah Poh
AU - Lowenstein, Lisa M.
AU - McKoy, June M.
AU - Noronha, Vanita
AU - Phillips, Tanyanika
AU - Rosko, Ashley E.
AU - Ruegg, Tracy
AU - Schiaffino, Melody K.
AU - Simmons, John F.
AU - Subbiah, Ishwaria
AU - Tew, William P.
AU - Webb, Tracy L.
AU - Whitehead, Mary
AU - Somerfield, Mark R.
AU - Mohile, Supriya G.
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2023/9/10
Y1 - 2023/9/10
N2 - PURPOSETo update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy.METHODSAn Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022.RESULTSA total of 26 publications met eligibility criteria and form the evidentiary basis for the update.RECOMMENDATIONSThe Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (65+ years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate.The Panel recommends the Practical Geriatric Assessment as one option for this purpose (https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf; https://youtu.be/jnaQIjOz2Dw; https://youtu.be/nZXtwaGh0Z0).Additional information is available at www.asco.org/supportive-care-guidelines.
AB - PURPOSETo update the ASCO guideline (2018) on the practical assessment and management of age-associated vulnerabilities in older patients undergoing systemic cancer therapy.METHODSAn Expert Panel conducted a systematic review to identify relevant randomized clinical trials (RCTs), systematic reviews, and meta-analyses from January 2016 to December 2022.RESULTSA total of 26 publications met eligibility criteria and form the evidentiary basis for the update.RECOMMENDATIONSThe Expert Panel reiterates its overarching recommendation from the prior guideline that geriatric assessment (GA), including all essential domains, should be used to identify vulnerabilities or impairments that are not routinely captured in oncology assessments for all patients over 65 years old with cancer. Based on recently published RCTs demonstrating significantly improved clinical outcomes, all older adults with cancer (65+ years old) receiving systemic therapy with GA-identified deficits should have GA-guided management (GAM) included in their care plan. GAM includes using GA findings to inform cancer treatment decision-making as well as to address impairments through appropriate interventions, counseling, and/or referrals. A GA should include high priority aging-related domains known to be associated with outcomes in older adults with cancer: physical and cognitive function, emotional health, comorbid conditions, polypharmacy, nutrition, and social support. Clinical adaptation of the GA based on patient population, resources, and time is appropriate.The Panel recommends the Practical Geriatric Assessment as one option for this purpose (https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/practice-patients/documents/2023-PGA-Final.pdf; https://youtu.be/jnaQIjOz2Dw; https://youtu.be/nZXtwaGh0Z0).Additional information is available at www.asco.org/supportive-care-guidelines.
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U2 - 10.1200/JCO.23.00933
DO - 10.1200/JCO.23.00933
M3 - Article
C2 - 37459573
AN - SCOPUS:85170110852
SN - 0732-183X
VL - 41
SP - 4293
EP - 4312
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 26
ER -