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Geriatric Assessment Instrument Utilization Among US Community Oncologists
Using standardized, geriatric assessment instruments to assist in making treatment decisions for elderly patients with cancer can improve their quality of life and reduce toxicity related to treatment. Moreover, the use of such instruments for this patient population is recommended in guidelines. To assess the attitudes of community oncologists toward these instruments as well as the extent to which they have incorporated them into their practices, researchers conducted a study aimed at assessing their knowledge and use of these instruments as well as their reasons for not using them (JCO Oncol Pract. 2022; doi:10.1200/OP.21. 00743).
To conduct this study, the researchers invited a cross-section of practicing US oncologists to attend live meetings and complete web-based surveys regarding treatment decision-making and challenges in oncology care. As a result, 349 oncologists were surveyed between September 2019 and February 2020, and nearly three-fourths of these respondents practiced in a community setting.
Survey results indicated that 60% of the respondents did not use a formal geriatric assessment instrument to inform treatment decisions for their elderly patients with cancer. The reasons for not using such an instrument most frequently given by the respondents were “Too cumbersome to incorporate into routine practice” (by 44%), “Adds no value beyond the comprehensive history and physical exam” (by 36%), and “Adds additional time to the office visit that my clinic schedule does not permit” (by 29%). Moreover, nearly 1 in 5 oncologists surveyed (19%) were not even aware of these instruments. Nevertheless, two-thirds believed that they are adequately equipped to care for geriatric patients with cancer.
“This study of predominantly community-based oncologists reveals that uptake of [geriatric assessment] is sparse in daily practice,” wrote Heidi Klepin, MD, MS, Wake Forest University School of Medicine, Winston-Salem, NC, and colleagues, adding, “Despite the evidence of its utility, further supported by guidelines from major professional organizations, the reasons for poor uptake are logistical, as in time and staff constraints, but also a perception of lack of value.”
“Furthermore, significant knowledge gaps were noted in recognizing validated [geriatric assessment] instruments and in the essential domains that constitute [geriatric assessment],” wrote the researchers.
The assessment factors the respondents used most frequently to inform treatment decisions for patients ≥75 years old were Eastern Cooperative Oncology Group performance status (by 88%) and comorbidities (by 73%). However, these measures “have been shown to be inadequate in providing a comprehensive assessment for older adults with cancer,” Dr Klepin and team asserted.
Only 13% of respondents used a geriatric assessment instrument for all of their elderly patients. The validated geriatric assessment instruments they most commonly used were the Mini-Mental State Exam (by 54%), the Comprehensive Geriatric Assessment (by 23%), the Cancer and Aging Research Group toxicity tool (by 12%), and the Chemotherapy Risk Assessment Scale for High-Age Patients tool (by 9%).
“Increasing education of the benefits of [geriatric-assessment] directed therapy could help to increase [geriatric assessment] utilization among community oncologists,” Dr Klepin and colleagues concluded.
