{"entity":{"id":"idea-acc-geriatric-assessment-by-default","kind":"idea","name":"Geriatric assessment by default for every patient over 70 starting cancer treatment","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"GAP70+ trial (Mohile et al., Lancet 2021)","url":"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01789-X/fulltext"}],"tags":[],"related":[],"cancers":[],"sections":["supportive-care"],"technologies":["geriatric-assessment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-aging-comorbidity","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"small","horizonYears":2},"route":"/ideas/idea-acc-geriatric-assessment-by-default/","neighbours":{"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"geriatric-assessment","kind":"technology","name":"Geriatric assessment","route":"/technologies/geriatric-assessment/"}],"bottleneck":[{"id":"b-aging-comorbidity","kind":"bottleneck","name":"Older and multimorbid patients are excluded and undertreated","route":"/bottlenecks/b-aging-comorbidity/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"idea":[{"id":"idea-acc-electronic-frailty-index-oncology","kind":"idea","name":"An automatic electronic frailty index inside the oncology record","route":"/ideas/idea-acc-electronic-frailty-index-oncology/"}],"paper":[{"id":"paper-gap70-geriatric-assessment-lancet-2021","kind":"paper","name":"GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth","route":"/key-papers/paper-gap70-geriatric-assessment-lancet-2021/"}],"roadmap":[{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}]}}