Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology Summary

The clinical practice guideline for older patients with cancer provides recommendations on the appropriate implementation of validated and standardized clinical assessment tools and decision-making models for this vulnerable and prevalent demographic group.1a It provides information on how these tools can be integrated into clinical oncology care to efficaciously evaluate and manage age-related conditions associated with adverse outcomes in older patients with cancer. ASCO believes that to improve the quality of care, oncologists and patients should carefully weigh the risks and benefits of cancer-directed therapy for patients with a low performance status, who are ineligible for a clinical trial, and for whom there is no strong evidence supporting the clinical value of standard cancer treatment.1,2 These conditions apply most often to older patients. Approximately 70% of patients with cancer are age 65 years and older.3 The number of patients with cancer over the age of 65 years is projected to significantly increase over the next 20 years.3 The lifetime probability of developing cancer in men and women aged 70 years and over is one in three and one in four, respectively.4 Although the majority of patients with cancer and who die of cancer are older, there is less evidence to guide chemotherapy treatment decisions for this population because older patients, especially those with age-associated conditions, are underrepresented in clinical trials. Less than 25% of patients enrolled in National Cancer Institute Cooperative Group Clinical Trials are age 65 to 74 years, and less than 10% are 75 years or older.5 Consequently, older patients are especially vulnerable to over-treatment (ie, less fit patients being provided with cancer treatment with low likelihood of benefit and high likelihood of complications/toxicity), or under-treatment (ie, fit older patients who are not provided with standard, evidence-based chemotherapy regimens).6-8 Older patients from minority backgrounds are the most vulnerable to disparities in survival.8 Studies have shown that traditional oncology performance measures, such as the Karnofsky or Eastern Cooperative Oncology Group performance status scores, do not accurately predict which older adults are at highest risk of adverse outcomes from chemotherapy.9,10 Implementing evidence-based approaches to the evaluation and management of aging-associated conditions in older patients could help inform decisions for chemotherapy and improve outcomes.2 Given the rapidly aging population, it is important that all oncology clinical teams