Further Study Warranted to Assess Value of Geriatric Assessment in Oncology Settings

Reference: 
J Natl Cancer Inst. 2012;104[15]:1134-1164

Martine Puts, PhD, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, ON, and colleagues conducted a systematic review of the use of geriatric assessment in oncology with the purpose of providing an overview of all geriatric assessment instruments used in the oncology setting, examining the feasibility and psychometric properties of those instruments, and systematically evaluating the effectiveness of geriatrics assessment in predicting or modifying outcomes ( J Natl Cancer Inst . 2012;104[15]:1134-1164). Using MEDLINE, Embase, PsychINFO, CINHAL, and the Cochrane library, the authors searched for articles published in English, French, Dutch, and German between January 1, 1996, and November 16, 2010, that focused on cancer patients with a mean age of 65 years or older. The researchers found 83 matching their inclusion criteria, three of which were written in French and the rest were in English. These studies evaluated the feasibility and effectiveness of geriatric assessment tools in cross-sectional, longitudinal, interventional, and observational settings.

Based on the MOOSE (Meta-analysis of Observational Studies in Epidemiology) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines for reporting, most of the studies ranged from poor to moderate quality. The 83 articles included in this review reported on 73 studies, 11 of which examined psychometric properties or diagnostic accuracy of the geriatric assessment instrument used. Twenty-five of the studies were conducted in North American, 43 in Europe, two in Asia, one in Australia, and two in multiple countries. Geriatric assessment was conducted in a hospital setting in 61 of the studies. A comorbidity domain was included in 58 studies while a nutritional assessment was conducted in 40 studies. Prescription information was collected in 22 studies and gait speed was included in 15 studies. Feasibility was addressed in 30 of the studies, including the time required for the assessment (10-45 minutes on average) and who conducted the assessment.

After reviewing the articles, the authors determined that geriatric assessment in the oncology setting is feasible, however, there is limited evidence that the assessment impacted treatment decision-making. Only four studies, all of which were conducted in France, examined the impact of geriatric assessment on the decision of cancer treatment; two of the four reported an impact of 40% to 50%, while the other two reported no impact. Puts and colleagues concluded that further research examining the impact of geriatric assessment in oncology settings is warranted. Additionally, there is a dearth of studies evaluating the impact of geriatric assessment on quality of life, an important consideration in cancer patients.