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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.
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.
The 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.
The result made geriatric assessment-guided management a guideline standard (ASCO 2023) for older adults receiving systemic therapy.
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.
Shares Supriya G. Mohile, Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Toxicity and quality of life are undervalued.
Shares Geriatric assessment by default for every patient over 70 starting cancer treatment, Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated, Wrong doses.
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.
Shares Geriatric assessment, Older and multimorbid patients are excluded and undertreated.