# Geriatric assessment by default for every older patient, and trials that admit them

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

## TL;DR

Most cancer patients are over 65, yet treatment is chosen by age and guesswork and trials exclude them. Assess fitness properly and design trials that include real older patients.

## Summary

Geriatric assessment-guided management reduced serious toxicity without compromising survival in randomised trials (GAP70+, GAIN). Uptake remains low and trial populations are far younger and fitter than practice. The proposal is a default assessment (short validated screen with full assessment when triggered) embedded in the record for all patients over 70 starting systemic therapy, payment for the assessment, and a requirement from regulators and funders that pivotal trials include older and comorbid patients in proportion to the treated population, with pre-specified analyses.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Default assessment reduces grade 3+ toxicity in older patients by a fifth, and trial populations shift within five years to include older patients in proportion to disease incidence.
- Rationale: Chronological age is a poor guide to tolerance; assessment tools are validated and quick, and trial exclusion is a habit rather than a scientific necessity.
- Proposed test: Roll out across a health system with toxicity and treatment completion as endpoints, and audit the age distribution in pivotal trials before and after the requirement.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Bottleneck evidence (Older and multimorbid patients are excluded and undertreated): Mohile et al., Evaluation of geriatric assessment and management on toxic effects of cancer treatment (GAP70+, Lancet 2021): https://doi.org/10.1016/S0140-6736(21)01789-X

## Connected records

- 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/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)
- 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/)
- ideas: [A dietitian in every gastrointestinal and head and neck tumour board](https://onco.cc/ideas/idea-nl-dietitian-in-every-mdt/)

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