Geriatric Assessment: Precision Medicine for Older Adults With Cancer

The majority of cancer diagnoses occur in adults over the age of 65 years; yet, because of under-representation in clinical trials, less evidence is available to guide the complex care for this population.1,2 Providing care for the growing number of older adults with cancer remains a clinical challenge and a critical need for the oncology field. In the era of precision medicine, when many patients routinely undergo expensive and exhaustive diagnostic testing, few oncologists use recommended and widely available geriatric assessments to aid in evaluating older patients and guide their treatment planning.3 The concept of precision medicine should extend beyond tumor-specific markers to incorporate host factors that are assessed as part of a routine geriatric assessment and have been demonstrated to significantly affect outcomes. The article accompanying this Commentary in Journal of Oncology Practice by Loh et al,4 contributed by the Young SIOG (International Society of Geriatric Oncology) interest group, describes the importance of performing a geriatric assessment in older adults with cancer and how treatment can be tailored based on geriatric assessment results. Although additional intervention trials and research are ongoing to address how geriatric assessment results can best be used to improve the outcomes of older adults with cancer, several studies have already established their ability to predict chemotherapy toxicity and survival in a variety of cancer settings.5,6 This prognostic information is immediately relevant to oncologic decision making and can aid in the discussion of the risks and benefits of cancer treatments. Geriatric assessment can also be used to identify areas of vulnerability that often are overlooked by traditional oncology evaluations, many of which have known effective treatments, such as falls and impairments in instrumental activities of daily living.7,8 Perhaps even more important than restating the known uses of geriatric assessment in clinical oncologic practice, this article provides practical information on overcoming perceived barriers to implementing the geriatric assessment into routine oncologic care. Lack of time should not be a barrier to implementing either geriatric screening tools or a geriatric assessment. Many geriatric assessments use patient-reported information that can be easily completed in the waiting room and do not require additional staff to administer. Even a simple one- to two-page evaluation can address many critical areas that often are overlooked by traditional assessments. Many short screening