{"entity":{"id":"idea-moon-geriatric-assessment-default","kind":"idea","name":"Geriatric assessment by default for every older patient, and trials that admit them","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"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)","url":"https://doi.org/10.1016/S0140-6736(21)01789-X"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":["geriatric-assessment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-aging-comorbidity","b-trial-diversity"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"medium","horizonYears":3},"route":"/ideas/idea-moon-geriatric-assessment-default/","neighbours":{"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-trial-diversity","kind":"bottleneck","name":"Trials do not represent the people who get cancer","route":"/bottlenecks/b-trial-diversity/"}],"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/"}],"idea":[{"id":"idea-nl-dietitian-in-every-mdt","kind":"idea","name":"A dietitian in every gastrointestinal and head and neck tumour board","route":"/ideas/idea-nl-dietitian-in-every-mdt/"}]}}