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geriatrics
Review
Comprehensive Geriatric Assessment as a Versatile
Tool to Enhance the Care of the Older Person
Diagnosed with Cancer
Janine Overcash 1, * , Nikki Ford 2, Elizabeth Kress 2, Caitlin Ubbing 2and Nicole Williams 2
1
The College of Nursing, The Ohio State University, 1585 Neil Ave, Newton Hall, Columbus, OH 43201, USA
2Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road,
Columbus, OH 43121, USA; Nikki.Ford@osumc.edu (N.F.); Eizabeth.Kress@osumc.edu (E.K.);
Caitlin.Ubbing@osumc.edu (C.U.); Nicole.Williams@osumc.edu (N.W.)
*Correspondence: Overcash.1@osu.edu
Received: 20 May 2019; Accepted: 20 June 2019; Published: 24 June 2019
Abstract:
The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older
person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to
Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community
oncology practices with varying levels of resources. The Society for International Oncology in
Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for
the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary
team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be
used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict
treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant
issues. Administrative support and proactive infrastructure planning to address scheduling, referrals,
and provider communication are critical to the effectiveness of the CGA.
Keywords: comprehensive geriatric assessment; CGA; multidisciplinary team; senior adult; cancer
Caring for the older adult who is diagnosed with cancer can be a complex orchestration of
managing existing comorbid conditions, cancer care, caregiver concerns, while maintaining quality of
life [
1
–
4
]. Older people have unique healthcare needs compared to younger adults who may not have
challenges regarding comorbidities [
4
–
7
], functional ability [
8
], transportation and social support [
9
].
Many academic and community cancer centers establish some type of multidisciplinary geriatric
oncology program to meet the needs of the older person [
10
–
15
]. The central element associated with
a geriatric oncology program is a comprehensive geriatric assessment (CGA). Despite the evidence
showing the benefits of CGA, only 9% and 8% of Phase II and Phase III clinical trials use CGA [
16
]. Many
healthcare settings do not use CGA also because of time constraints, availability of a multidisciplinary
team, and lack of professionals trained in geriatrics/gerontology. Conducting a CGA is feasible in
ambulatory geriatric oncology programs (AGOPs) [
10
,
17
] including radiation therapy and surgical
oncology [
18
–
20
]. There are strategies to reduce the time and resources often required to conduct a
CGA. The purpose of this article is to illustrate how CGA can be used in different types of AGOPs and is
a feasible option despite limited time and personnel. A review of the classic and current literature was
conducted using the Ohio State University (OSU) Health Sciences Library (HSL) including PubMed
and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to support this article.
1. Defining a Comprehensive Geriatric Assessment
A CGA is a battery of screening tools necessary to uncover actual and potential limitations that
can compromise cancer diagnosis and treatment [
21
]. The Society for International Oncology in
Geriatrics 2019,4, 39; doi:10.3390/geriatrics4020039 www.mdpi.com/journal/geriatrics
Geriatrics 2019,4, 39 2 of 13
Geriatrics (SIOG) recommends a CGA be administered to older patients who are receiving cancer
care [
22
,
23
]. Benefits of a CGA are prolonged survival [
24
], prediction of those who may not benefit
from treatment [
25
], prediction of mortality [
26
], of cancer treatment tolerance [
27
], of chemotherapy
toxicities [
28
], of surgical complications [
29
], and aid in decision-making to help avoid over- and
undertreatment of cancer [
30
]. The battery of screening tools is generally assembled to address common
problems associated with aging; however, any number of valid and reliable clinical instruments can
be included, depending on the resources. Some cancer centers may be able to conduct large-scale
CGA with a robust multidisciplinary team (MDT), and others may limit assessment instruments and
MDT members.
The comprehensive character of geriatric assessment allows clinicians to gain perspective beyond
the traditional oncology-related history and physical exam [
31
]. A CGA can detect previously
unidentified problems in approximately 70% of patients [
32
], which can impact cancer treatment [
19
]
and provide the foundation for a treatment plan to address malignant and nonmalignant conditions [
33
].
CGA is used to develop and refine a cancer management plan specific to the needs of the person
diagnosed with cancer [
20
]. A prime goal of geriatric oncology is helping an older person achieve the
best health possible while receiving cancer care to maintain independence [4].
2. Instruments Included in a Comprehensive Geriatric Assessment
Generally, screening tools to detect depression [
34
], comorbidity [
35
], cognitive impairment [
36
],
functional status [
37
,
38
], risk for falls [
39
], and nutritional status [
40
] are commonly included in a
CGA. The CGA is multidimensional in that many types of screening instruments can be included to
meet the needs of people who are diagnosed with cancer or who are receiving end-of-life care [
41
],
caregivers [
42
], and providers [
43
]. SIOG recommends a variety of instruments that can be tailored to
any patient population [44].
When choosing instruments to include in a CGA, consider that there are performance-based
evaluations and self-report measures. Performance-based evaluations provide a depiction of a person’s
capability using tools such as the Timed Up and Go Test (TUAGT) [
45
], balance testing [
46
], grip
strength [
47
], sit-to-stand test [
48
], cognitive screening using the Clock Drawing Test [
49
], and other
empirically measured tests. Self-report measures are also commonly included in the CGA, such
as the Geriatric Depression Scale (GDS) [
34
], Activities of Daily Living Scale [
37
], Instrumental
Activities of Daily Living [
38
], quality-of-life measures [
50
], and nutritional assessment [
40
]. Self-report
measures tend to be rather easy to use and have validity and reliability metrics for clinical and research
use. Including both self-report and performance-based evaluations provides patient perception
of functioning at home in conjunction with an objective assessment. Some patients may tend to
over-estimate their functional ability, and the empirical observation of task performance may help
providers develop realistic management plans.
Supporting the caregiver is also important to the health of the person with cancer [
51
]. The Modified
Caregiver Strain Index [
52
,
53
] is a 13-item tool that measures the financial, psychological, personal,
physical, and social domains of caregiving which can be incorporated into a CGA. Caregivers of people
diagnosed with cancer who have functional impairment [
54
] and have increased comorbidity [
55
]
report greater strain and burden. CGA can stratify people with cancer into levels of caregiver burden
risk so that clinicians can recognize caregivers who may need help [
42
]. Caregivers of people with
advanced cancer often neglect their own health and wellness and report high levels of depression
and anxiety [
56
]. Depression is not rare among caregivers (42%), and clinicians must support and
encourage health maintenance and wellness [
57
]. If caregiver health is not maintained and perceptions
of strain and burden exist, the individual with cancer is at risk for re-hospitalization [
58
] and increased
morbidity/mortality [
59
]. Help for caregivers navigating community resources, Medicare, insurance,
and cancer treatment can be very welcomed [
60
]. Cancer can be overwhelming and expensive, and
providing psychosocial support can reduce caregiver stress associated with financial toxicity [
61
],
Geriatrics 2019,4, 39 3 of 13
address depression, and establish coping strategies [
62
]. No matter the scale of the CGA, caregiver
support is important to geriatric oncology.
3. Multidisciplinary Team
A MDT has historically been used in geriatrics to administer the CGA and manage the many
interwoven concerns that can affect older people [
63
,
64
]. An MDT can be composed of physicians,
social workers, pharmacists, nurses, nurse practitioners, dietitians, physical therapists, and other
types of healthcare professionals. Not every clinic may have access to a variety of specialists, and
it is important to remember that geriatric care and screening can be provided by physicians, nurse
practitioners, and nurses. An MDT may simply include a physician and a nurse who are trained in
geriatrics. Administering and coordinating a CGA is well within the scope of practice of nursing and
can be central to the effectiveness of the MDT [65].
Whatever the size, an MDT functions symbiotically to assess, manage, and monitor many
limitations and complications associated with aging and deconditioning [
66
]. Geriatric oncology
has adopted the MDT approach to improve or maintain independence [
67
] and to provide CGA by
which to impact the cancer management plan [
20
]. Key to an effective MDT are communication,
collaboration, and coordination [
68
]. A social worker, nurse practitioner, and dietitian can evaluate
a patient simultaneously and hear the responses from individual assessments, so that questions are
not duplicated. This method requires a cohesive teamwork, does save some time, and enhances
communication within the MDT. An MDT with a perception of cohesive teamwork provides higher
quality of care and less attrition in the nursing staff[
69
]. Communication with primary care providers
and other specialists is critical to geriatric oncology and successful interventions [
70
]. When primary
care providers and oncology providers agree on recommendations, adherence to CGA recommendations
is more likely to occur [71].
For providers who lack a MDT, nurse-conducted CGA is a viable option. Nurses and/or advanced
practice nurses often function in the role of coordinator, provider, communicator, and organizer.
Awareness of the current knowledge in normative aging, geriatric syndromes, wellness, and prevention
are components of nursing best practices [
72
]. Best practices in geriatric/gerontological competencies
are provided by the American Association of Colleges of Nursing (AACN) for advanced practice and
baccalaureate nurses and largely guide curriculum development for colleges of nursing throughout the
United States [
73
,
74
]. However, geriatric training is often lacking in nursing schools throughout the
country [
75
], and geriatric education is often received outside of the academic curriculum. The National
Hartford Center of Gerontological Nursing Excellence (NHCGNE) aims to enhance gerontological
education among nurses in the academic and clinical workforce [
76
]. The NHCGNE recognizes
gerontological nurse educators as
Distinguished Educators in Gerontological Nursing Program
for
working with faculty to enhance university and college curricula, educate nursing students at all levels,
and work with other providers to better care for the older person [
77
]. It is important that nurses are
educated in gerontology/geriatrics so they are prepared to assess and contribute to the care of the older
person who is diagnosed with cancer [78].
4. Management of Problems Detected by Comprehensive Geriatric Assessment
Geriatric syndromes (poor functional status, cognitive impairment, frailty), life expectancy, and
comorbidity are realities that oncology providers must consider when caring for older individuals.
The mean number of geriatric syndromes is 2.9 in community-dwelling older people [
79
] and when
uncontrolled, may interfere with cancer treatment. Complex problems associated with geriatric
syndromes often cannot be addressed in one clinic visit or with a single medication or intervention.
For frailer people, determining the cause of a problem may require an MDT-administered CGA and
several clinic visits to detect and manage complex problems [
80
]. Good general health and absence of
severe comorbidity allow older people to be considered for surgical [
81
] and other types of standard
treatments [82].
Geriatrics 2019,4, 39 4 of 13
People who have well-managed comorbidities may not have any deterioration in their functional
status or life expectancy. In non-metastatic prostate cancer patients receiving treatment, 10-year life
expectancy was not impacted by comorbid conditions nor age [
83
]. However, data show that for every
chronic condition, life expectancy decreases 1.8 years [
61
]. Life expectancy, comorbid conditions, and
functional status are sentinel factors in geriatric oncology [
84
]. Functional status and not chronological
age is an important consideration in cancer treatment planning for the older adult [28,85].
Initiating a CGA requires a process to manage the limitations uncovered by the evaluation, and
providers should be trained on how to incorporate the MDT recommendations in the decision-making
process [
86
]. The mean number of CGA recommendations to address the uncovered limitations ranges
from seven [
87
] to two [
88
], depending on the type of patient (frail, vulnerable, or fit) [
89
]. A CGA
performed upon an initial oncology encounter can render three interventions [
90
]. Patients are most
likely to adhere to four or less recommendations unless they present cognitive decline, in which case
adherence is lower [87].
Follow-up care is important to determine adherence to recommendations and to reassess the
issues that were previously detected [
91
]. The problems detected in the CGA should be managed or
referred and detailed in the medical record [
92
,
93
]. How often to administer the CGA depends on
the degree of fitness or frailty of the patient. A primary care nurse who is trained in geriatrics can be
effective in coordinating the recommendations [94].
5. Comprehensive Geriatric Assessment with Limited Resources
A CGA conducted by an MDT can require an hour or more to administer; however, there are
strategies to conduct CGA in a timely and efficient manner. Targeting the person who would most
likely benefit from the CGA with a prescreening instrument can help preserve the resources of clinical
time and personnel and reduce the respondent burden (Figure 1).
Geriatrics 2019, 4 FOR PEER REVIEW 4
People who have well-managed comorbidities may not have any deterioration in their
functional status or life expectancy. In non-metastatic prostate cancer patients receiving treatment,
10-year life expectancy was not impacted by comorbid conditions nor age [83]. However, data show
that for every chronic condition, life expectancy decreases 1.8 years [61]. Life expectancy, comorbid
conditions, and functional status are sentinel factors in geriatric oncology [84]. Functional status and
not chronological age is an important consideration in cancer treatment planning for the older adult
[28,85].
Initiating a CGA requires a process to manage the limitations uncovered by the evaluation, and
providers should be trained on how to incorporate the MDT recommendations in the decision-
making process [86]. The mean number of CGA recommendations to address the uncovered
limitations ranges from seven [87] to two [88], depending on the type of patient (frail, vulnerable, or
fit) [89]. A CGA performed upon an initial oncology encounter can render three interventions [90].
Patients are most likely to adhere to four or less recommendations unless they present cognitive
decline, in which case adherence is lower [87].
Follow-up care is important to determine adherence to recommendations and to reassess the
issues that were previously detected [91]. The problems detected in the CGA should be managed or
referred and detailed in the medical record [92,93]. How often to administer the CGA depends on the
degree of fitness or frailty of the patient. A primary care nurse who is trained in geriatrics can be
effective in coordinating the recommendations [94].
5. Comprehensive Geriatric Assessment with Limited Resources
A CGA conducted by an MDT can require an hour or more to administer; however, there are
strategies to conduct CGA in a timely and efficient manner. Targeting the person who would most
likely benefit from the CGA with a prescreening instrument can help preserve the resources of clinical
time and personnel and reduce the respondent burden (Figure 1).
Figure 1. Prescreening using CGA to Determine Further Treatment or Diagnostics.
Prescreens have been developed, such as the abbreviated CGA [95], the G8 [96], and the
Vulnerable Elders Survey-13 [97]. SIOG recommends several valid and reliable pre-screen tools [1].
The purpose of pre-screen tools is to target those who most benefit from conducting the entire CGA,
rather than to replace a CGA. People who have functional decline and a higher risk of mortality and
of cancer treatment complications tend to benefit from the CGA [98,99]. For those people who are
independent and with minimal comorbid conditions, a CGA may not be as beneficial [100].
Depending on resources and type of healthcare setting, a CGA can be fashioned to include only
several instruments rather than an exhaustive battery of tools requiring hours of clinic encounter
time. Creating a smaller version of CGA which can include two or three screening instruments (GDS,
Mini-Cog, TUAGT) will allow time to gain experience administering the instrument and managing
the limitations. Using only two or three screening instruments has reasonable benefit to people who
are diagnosed with cancer and to their families. The detection and management of depression can
contribute to better cancer treatment outcomes, particularly with adherence to recommendations
[101]. Benefits of screening for cognitive limitations are inconclusive [102]; however, other
Figure 1. Prescreening using CGA to Determine Further Treatment or Diagnostics.
Prescreens have been developed, such as the abbreviated CGA [
95
], the G8 [
96
], and the Vulnerable
Elders Survey-13 [
97
]. SIOG recommends several valid and reliable pre-screen tools [
1
]. The purpose
of pre-screen tools is to target those who most benefit from conducting the entire CGA, rather than
to replace a CGA. People who have functional decline and a higher risk of mortality and of cancer
treatment complications tend to benefit from the CGA [
98
,
99
]. For those people who are independent
and with minimal comorbid conditions, a CGA may not be as beneficial [100].
Depending on resources and type of healthcare setting, a CGA can be fashioned to include only
several instruments rather than an exhaustive battery of tools requiring hours of clinic encounter
time. Creating a smaller version of CGA which can include two or three screening instruments (GDS,
Mini-Cog, TUAGT) will allow time to gain experience administering the instrument and managing
the limitations. Using only two or three screening instruments has reasonable benefit to people who
are diagnosed with cancer and to their families. The detection and management of depression can
contribute to better cancer treatment outcomes, particularly with adherence to recommendations [
101
].
Benefits of screening for cognitive limitations are inconclusive [
102
]; however, other considerations
Geriatrics 2019,4, 39 5 of 13
such as planning, awareness of limitations, preparation for future and other important tasks can be very
helpful for patients and families. Screening using the TUAGT can lead to physical therapy consults [
88
]
to enhance lower extremity strength and to provide falls education and proactive planning should a
fall occur (determining how to get help, keeping a phone on the bathroom floor near the bathing area).
The use of three tools can provide the opportunity to address common problems that can be associated
with aging without requiring the time to conduct a more robust CGA (Figure 2).
Geriatrics 2019, 4 FOR PEER REVIEW 5
considerations such as planning, awareness of limitations, preparation for future and other important
tasks can be very helpful for patients and families. Screening using the TUAGT can lead to physical
therapy consults [88] to enhance lower extremity strength and to provide falls education and
proactive planning should a fall occur (determining how to get help, keeping a phone on the
bathroom floor near the bathing area). The use of three tools can provide the opportunity to address
common problems that can be associated with aging without requiring the time to conduct a more
robust CGA (Figure 2).
Figure 2. Smaller CGA to Determine Further Treatment or Diagnostics.
The use of pre-screens and a smaller battery of assessment instruments is a viable option when
using CGA with limited clinical resources. Understanding the versatility of CGA may motivate more
clinicians to employ best practices in geriatric assessment.
Cost and resources are a factor when establishing a geriatric oncology program; however, not
all data indicate that CGA is cost-prohibitive when looking at long-term expenses and hospital stay.
The SIOG suggests that CGA is cost-effective and reduces hospitalizations [103]. CGA in people who
experience a hip fracture reduces hospital costs and hospital length of stay and improves health
outcomes [104]. However, for those people admitted to the hospital for nonmalignant conditions,
CGA is thought to slightly increase costs [105]. A Swedish study found ambulatory oncology CGA
to have increased costs due to the number of interventions and increased survival [25]. Another
Swedish study found ambulatory CGA to increase survival in frail people, with fewer hospital days
and without higher costs [106]. In the United States, the cost savings or expenses may be different,
however, people tend to benefit from CGA [85,107].
6. Models of Geriatric Oncology Programs using CGA
AGOPs often include regular CGAs and manage a patient throughout cancer care. There are
different types of AGOPs, such as those that provide ongoing geriatric oncology management, one-
time consult programs, site specific programs, and programs that address patients according to age
and not a particular tumor type. Scale also varies among AGOPs, with some using large MDTs and
others consisting of an oncologist and a geriatric trained nurse. Regardless of the structure, AGOPs
can provide CGA and offer management strategies to enhance the care of the older person diagnosed
with cancer.
The CGA can be administered by a nurse or nurse practitioner, and scores on the measures can
be shared with the entire MDT, so that more in-depth screening can be conducted by the appropriate
specialists. In some situations, the MDT members individually screen new patients to establish a
baseline condition prior to cancer treatment. The MDT members can then evaluate the patient as
needed throughout cancer treatment. Established patients who have received a baseline CGA can
receive regular geriatric assessment screening every 6 months or every year. No data exist on how
often to conduct a CGA; however, frail or vulnerable patients may require more frequent screening.
Figure 2. Smaller CGA to Determine Further Treatment or Diagnostics.
The use of pre-screens and a smaller battery of assessment instruments is a viable option when
using CGA with limited clinical resources. Understanding the versatility of CGA may motivate more
clinicians to employ best practices in geriatric assessment.
Cost and resources are a factor when establishing a geriatric oncology program; however, not
all data indicate that CGA is cost-prohibitive when looking at long-term expenses and hospital stay.
The SIOG suggests that CGA is cost-effective and reduces hospitalizations [
103
]. CGA in people
who experience a hip fracture reduces hospital costs and hospital length of stay and improves health
outcomes [
104
]. However, for those people admitted to the hospital for nonmalignant conditions, CGA
is thought to slightly increase costs [
105
]. A Swedish study found ambulatory oncology CGA to have
increased costs due to the number of interventions and increased survival [
25
]. Another Swedish study
found ambulatory CGA to increase survival in frail people, with fewer hospital days and without
higher costs [
106
]. In the United States, the cost savings or expenses may be different, however, people
tend to benefit from CGA [85,107].
6. Models of Geriatric Oncology Programs Using CGA
AGOPs often include regular CGAs and manage a patient throughout cancer care. There are
different types of AGOPs, such as those that provide ongoing geriatric oncology management, one-time
consult programs, site specific programs, and programs that address patients according to age and not
a particular tumor type. Scale also varies among AGOPs, with some using large MDTs and others
consisting of an oncologist and a geriatric trained nurse. Regardless of the structure, AGOPs can
provide CGA and offer management strategies to enhance the care of the older person diagnosed
with cancer.
The CGA can be administered by a nurse or nurse practitioner, and scores on the measures can be
shared with the entire MDT, so that more in-depth screening can be conducted by the appropriate
specialists. In some situations, the MDT members individually screen new patients to establish a
baseline condition prior to cancer treatment. The MDT members can then evaluate the patient as
needed throughout cancer treatment. Established patients who have received a baseline CGA can
receive regular geriatric assessment screening every 6 months or every year. No data exist on how
Geriatrics 2019,4, 39 6 of 13
often to conduct a CGA; however, frail or vulnerable patients may require more frequent screening.
The National Comprehensive Cancer Network (NCCN) has established guidelines for using CGA
when caring for the older adult [
108
]. A pre-cancer treatment decision tree addresses how and when to
use a prescreening and an entire CGA and how CGA can impact treatment decisions for the patient,
family, and provider [108].
Scheduling new and established patients visits for any type of AGOP requires planning for
extra time to conduct the CGA. For AGOPs conducting the entire CGA with an MDT in addition
to establishing a cancer management plan, a new patient visit may require two hours. For those
AGOPs using limited measures in the CGA and a limited MDT, perhaps a 30 min visit is appropriate.
One-time CGA consults can be easier to schedule in that all patients tend to receive the same screening
instruments and assessment from the MDT. Generally, the consult can be conducted in approximately
1.5 to 2 h per patient. Depending on the physical environment of the clinic, three patients can be
scheduled every 2–2.5 hour and be accommodated with rotating members of the team conducting
the assessments.
An AGOP one-time CGA consult functions to provide recommendations for cancer treatment,
identifies comorbid conditions, and addresses actual and potential risk factors that can affect health and
independence. A one-time CGA consult can be helpful to surgical teams to predict complications [
109
]
and post-surgical delirium when administered prior to surgery [
110
]. A one-time CGA conducted by a
geriatrician prior to emergency surgery reduces hospital length of stay by 55 days [
111
]. Despite the
positive contributions of CGA, many surgeons and other providers fail to consult geriatric services [
112
].
Education on the benefits of CGA in cancer treatment decision-making is critical for all cancer specialties
and providers.
Conducting a CGA and incorporating an MDT require infrastructures and administrative support
to lay the foundation for a sustainable geriatric oncology. Often, facilities and providers have difficulty
launching and maintaining senior adult programs, for many reasons [
113
]. Patient scheduling to
accommodate longer visit times [
114
], avenues of referral when limitations are found, adapting the
medical record to accommodate scores and recommendations are important tasks to address before
initiating geriatric assessment [
13
]. AGOPs require continued evaluation and maintenance to ensure
the process of clinic is working well and the MDT is functioning effectively and productively. Regular
team meetings can be helpful to discuss assessment process, patients, and research activities. Regular
meetings should include administration, office staffwho schedule patient visits, as well as people who
work with medical records, who can be helpful in establishing highly functioning clinics, especially in
big medical centers. MDT meetings prior to geriatric oncology clinic are very useful to review new
and established patients.
A prime component of infrastructure is communication with other providers, which is key to the
effectiveness of AGOPs. Many providers feel under-utilized in the development of cancer management
plans, and communication is often poor between oncologists and primary care providers [
94
]. Proactive
planning to establish avenues of communication to coordinate the CGA recommendations can reduce
redundant assessments and increase effectiveness. Follow-up care and adherence to recommendations
are likely to be improved with better communication between geriatric MDTs and other providers and
typically require organizational modifications for adequate transfer of patient information [115].
Patient referral to an AGOP is also a consideration when establishing a clinic or a process for other
oncology providers to refer patients for a one-time CGA consult or ongoing management. Awareness
of the AGOP should be created within the organization and the community. Often, community
members are not aware of geriatric oncology services, and providing educational symposiums or brief
presentations at various sites common to potential patients and families can offer the opportunity to
receive a CGA and cancer care.
An AGOP can provide valuable clinical data to enhance the care of the older person diagnosed
with cancer. Establishing a research protocol incorporating CGA data can help improve the science
of geriatric oncology and establish a foundation for future funding. Select CGA instruments can be
Geriatrics 2019,4, 39 7 of 13
useful clinically as well as appropriate for research. Dissemination is critical to geriatric oncology and
helps address the importance of CGA in the care of the older person diagnosed with cancer.
7. Conclusions
CGA is a versatile tool that can be integrated into various oncology clinics and specialties to
provide the best care for the older person. Integrating a CGA does require administrative support,
infrastructure for patient scheduling, MDT involvement, and a great deal of planning. The importance
of understanding the needs of older people with cancer and of their caregivers underscores the
significance of CGA and inspires a comprehensive view, helpful to make treatment decisions. CGA
is the central element of geriatric oncology and the gold standard of practice to meet the needs of
older people.
Author Contributions:
Individual contributions are as follows: conceptualization, writing original—draft
preparation, writing- review and editing draft preparation was performed by J.O., conceptualization
writing—review and editing draft preparation was completed by E.K., N.F., C.U. and N.W.
Funding: This research received no external funding.
Acknowledgments:
We would like to thank the Stephanie Spielman Comprehensive Breast Cancer for continued
support of geriatric oncology and our Senior Adult Oncology Program.
Conflicts of Interest: We have no conflicts of interest to declare.
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