# Geriatric assessment by default for every patient over 70 starting cancer treatment

Source: https://onco.cc/ideas/idea-acc-geriatric-assessment-by-default/  
OnCo record `idea-acc-geriatric-assessment-by-default` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A short structured check of memory, mobility, nutrition and medicines before treatment cuts serious side effects in older patients without reducing benefit. It should be automatic, not optional.

## Summary

Randomised trials (GAP70+, GAIN, and others) showed that geriatric assessment with management recommendations reduces grade 3 or higher toxicity in older patients receiving chemotherapy, and ASCO guidelines recommend it. Uptake remains low because it is seen as extra work. Embedding a validated screening tool (such as G8) in intake, with automatic full assessment and management recommendations for positive screens, delivered by nurses, would make it the default.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Default geriatric assessment will reduce grade 3 or higher treatment toxicity in patients over 70 by at least 20% and reduce unplanned admissions, without reducing treatment completion for curative-intent therapy.
- Rationale: Level 1 evidence of benefit exists; the failure is implementation, which defaults address.
- Proposed test: A stepped-wedge implementation across 20 centres with toxicity, admissions, treatment completion, and functional decline at six months as endpoints.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- GAP70+ trial (Mohile et al., Lancet 2021): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01789-X/fulltext

## Connected records

- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/)
- bottlenecks: [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- ideas: [An automatic electronic frailty index inside the oncology record](https://onco.cc/ideas/idea-acc-electronic-frailty-index-oncology/)
- key papers: [GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth](https://onco.cc/key-papers/paper-gap70-geriatric-assessment-lancet-2021/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

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