How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study

J Geriatr Oncol. 2019 Nov;10(6):951-959. doi: 10.1016/j.jgo.2019.04.006. Epub 2019 Apr 26.


Introduction: With the accumulating evidence on the added value on prediction of outcomes of geriatric assessment (GA) in older patients with cancer, the question shifts from whether performing a GA is useful, to how to implement this into standard practice in a feasible and effective way. The effect of implementing GA, and assessment of patient preferences on treatment recommendations by an onco-geriatric multidisciplinary team (MDT), was compared to the recommendation previously made by the tumor board (care as usual).

Methods: Patients aged 70 years and older with a solid malignancy who were referred to a tertiary care center for diagnosis and treatment recommendations, as provided by a tumor board, were included. The intervention consisted of: a nurse-led GA and assessment of patient preferences prior to the start of oncological treatment, discussing this in an onco-geriatric MDT, and weighing all this information in a structured, stepwise manner. Treatment recommendations formulated by this onco-geriatric MDT were compared to the treatment recommendations by the tumor board.

Results: Of 236 eligible patients, 197 were included. For 27%, treatment recommendations from the onco-geriatric MDT differed from the recommendations formulated by the tumor board. These modifications were mostly towards less intensive curative or palliative treatment. Thirteen percent of patients were subsequently referred to a geriatrician in order to reach a treatment recommendation.

Discussion: Implementing an onco-geriatric care trajectory, using GA and assessment of patient preferences, resulted in an adjustment of treatment recommendations for a quarter of patients. Thirteen percent needed subsequent referral to a geriatrician.

Keywords: Clinical decision-making; Geriatric assessment; Implementation; OPT tool; Older patients with cancer; Patient preferences.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Clinical Decision-Making / methods*
  • Female
  • Geriatric Assessment / methods*
  • Geriatrics / methods
  • Humans
  • Male
  • Medical Oncology / methods
  • Neoplasms / therapy*
  • Patient Preference*
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data