ASCO issues guideline recommending older adults with cancer to receive geriatric assessment

Reviewed by James Ives, M.Psych. (Editor)Apr 8 2019

Although the majority of patients who have blood cancers are older adults, they make up only a small percentage of participants in the clinical trials that lead to new therapies. That's because the standard research methods used in oncology (cancer medicine) are not ideal for identifying certain vulnerabilities linked to aging, such as having multiple chronic diseases and being frail.

To help remedy that situation, the American Society of Clinical Oncology (ASCO) issued a guideline recommending that older adults who have cancer receive a geriatric assessment to see if they are at increased risk for experiencing side effects from medication and other complications from cancer and its treatment. Recently, a team of researchers examined older adults who have cancer to see whether their ability to manage daily activities as measured by these assessments was linked to staying alive longer. The team published their study in the Journal of the American Geriatrics Society.

A key part of the geriatric assessment is to determine how well an older adult performs the basic activities of daily living (ADLs). These include bathing, dressing, getting themselves from a chair to the bed (and vice versa), eating, grooming, and using the toilet. The geriatric assessment also takes into account an older adult's ability to perform instrumental activities of daily living (IADLS), or activities necessary for them to live on their own in the community. These activities include shopping, preparing meals, housework, taking medication, and handling their finances.

The researchers studied how performing daily activities was linked to survival and also to the use of medical care for adults living with cancer and aged 75 years and older. The researchers suspected that being unable to perform their daily activities would mean higher rates of death and unexpected visits to the Emergency Department (ED) and admissions to the hospital.

Participants included 464 people who on average were nearly 80 years old; 65 percent were male. All the participants were treated for blood cancers, including leukemia, multiple myeloma, and lymphoma, at the Dana-Farber Cancer Institute in Boston. About 38 percent of the participants had an aggressive form of blood cancer.

Of the participants, 11 percent reported they had trouble with at least one ADL and almost 27 percent had trouble performing at least one IADL.

The researchers also looked at a group of 318 participants who had visited the ED or had unplanned hospitalizations. Of them, 17 percent had at least one ED visit and 19 percent had at least one unplanned hospitalization. The five most common causes of hospitalization were pneumonia, fever, sepsis (the medical term for a blood infection), pain, and congestive heart failure.

For their main findings, the researchers reported that participants who had trouble performing at least one IADL had a higher risk for death, ED visits, and unplanned hospitalizations. This risk was not affected by how old they were, whether they had other chronic illnesses, how aggressive their cancers were, or the intensity of their cancer treatment.

What's more, the researchers found that many of the patients who were dependent in performing their IADLS (meaning they relied on help from others) also had higher rates of age-related conditions, such as memory issues, problems with mobility, and feelings of loneliness or depression. The researchers concluded from their study that it is not only important to ask about function for older adults with blood cancer but to also screen for age-related conditions that could limit functioning. Treating these other conditions to improve function might help older adults better tolerate the stress of blood cancers and their treatment, the researchers suggested.