{"entity":{"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","aka":[],"tldr":"When oncologists received a geriatric assessment summary with management recommendations for patients aged 70 or over, grade 3-5 toxicity fell from 71% to 51% with no loss in survival.","summary":"GAP70+ was a cluster-randomised trial in 40 US community oncology practices. Patients aged 70 or over with advanced cancer and at least one impaired geriatric domain who were starting a new palliative chemotherapy or other high-risk regimen were enrolled (718 patients). Intervention practices received a geriatric assessment summary and tailored recommendations; usual-care practices received only alerts for depression and cognitive impairment.\n\nThe primary endpoint, grade 3-5 toxicity over 3 months, occurred in 51% of intervention patients versus 71% in usual care (relative risk 0.74). Oncologists in the intervention arm more often reduced dose intensity at cycle 1, and 6-month and 1-year survival did not differ. A companion trial (GAIN, JAMA Oncology 2021) found a similar toxicity reduction.\n\nThe result made geriatric assessment-guided management a guideline standard (ASCO 2023) for older adults receiving systemic therapy.","asOf":"2026-09-08","links":[{"label":"DOI","url":"https://doi.org/10.1016/S0140-6736(21)01789-X"},{"label":"ClinicalTrials.gov NCT02054741","url":"https://clinicaltrials.gov/study/NCT02054741"}],"tags":[],"related":["idea-moon-geriatric-assessment-default","idea-acc-geriatric-assessment-by-default","idea-tr1-geriatric-dose-finding-cohorts","idea-acc-upfront-reduced-dose-trials-frail"],"cancers":[],"sections":["supportive-care"],"technologies":["geriatric-assessment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-aging-comorbidity","b-toxicity-qol","b-dose-optimisation"],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"The Lancet","year":2021,"doi":"10.1016/S0140-6736(21)01789-X","pmid":"34741815","authors":"Mohile SG, Mohamed MR, Xu H, et al.","paperType":"rct","findings":["Grade 3-5 toxic effects 51% vs 71% (relative risk 0.74, 95% CI 0.64-0.86)","Cycle 1 dose reduction 49% vs 35% in the intervention arm","No difference in 6-month overall survival (71% vs 74%) or 1-year survival","Falls and polypharmacy-related events were also reduced with geriatric management"],"whatItMeans":"Older patients are more likely to be harmed by standard-dose chemotherapy, and a structured assessment of function, cognition, nutrition and social support lets oncologists adjust treatment safely. Starting lower does not appear to shorten life. Most older patients still do not get such an assessment.","caveats":["Cluster randomisation at practice level with modest numbers per practice","Toxicity was the primary endpoint; quality-of-life and functional outcomes were secondary","Intervention effect depends on oncologists acting on recommendations; adherence varied","Excludes curative-intent settings, where dose reductions are riskier"],"changedPractice":true,"participants":718},"route":"/key-papers/paper-gap70-geriatric-assessment-lancet-2021/","neighbours":{"idea":[{"id":"idea-tr1-geriatric-dose-finding-cohorts","kind":"idea","name":"Dose-finding in older and frail patients, not extrapolation from fit ones","route":"/ideas/idea-tr1-geriatric-dose-finding-cohorts/"},{"id":"idea-moon-geriatric-assessment-default","kind":"idea","name":"Geriatric assessment by default for every older patient, and trials that admit them","route":"/ideas/idea-moon-geriatric-assessment-default/"},{"id":"idea-acc-geriatric-assessment-by-default","kind":"idea","name":"Geriatric assessment by default for every patient over 70 starting cancer treatment","route":"/ideas/idea-acc-geriatric-assessment-by-default/"},{"id":"idea-acc-upfront-reduced-dose-trials-frail","kind":"idea","name":"Upfront reduced-dose regimens tested head-to-head in frail older patients","route":"/ideas/idea-acc-upfront-reduced-dose-trials-frail/"}],"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/"},{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}],"person":[{"id":"supriya-mohile","kind":"person","name":"Supriya G. Mohile","route":"/people/supriya-mohile/"}]}}