The importance and challenges for improving geriatric assessments

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Published: 23 Nov 2018
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Dr Marije Hamaker - Diakonessenhuis, Utrecht, Netherlands

Dr Marije Hamaker speaks to ecancer at the International Society of Geriatric Oncology 2018 conference in Amsterdam about geriatric assessments.

She discusses the results of her systematic review on the effect of a geriatric evaluation on treatment decisions and outcome.

Dr Hamaker also emphasises the importance of making this assessment as universal as possible and understanding that it's a resource dependant process.

This service has been kindly supported by an unrestricted grant from Janssen Oncology.

I presented the results of a systematic review that I did and that was published in The Journal of Geriatric Oncology earlier this year where we had the results of 36 publications on the effect of a geriatric evaluation on treatment, treatment decisions and outcome. I think we’ve known for quite a while that there has been lots of data that shows that if you do a geriatric assessment clinicians tend to change their treatment plan or the multidisciplinary team changes their treatment plan and also that a lot of non-oncologic interventions are implemented or at least recommended. The uptake is quite varying of these recommendations but what we wanted to show with this paper is the data that’s now available of the actual effect on treatment outcome. So one of the studies, quite well known within the geriatric community, it was published in The Journal of Clinical Oncology by Romain Corre in 2016 and it was a randomised study where the one arm had standard care and the other arm had geriatric assessment based treatment allocation which showed that there was less under- and over-treatment, less toxicity, a better completion rate without compromising the oncologic outcomes. So that’s the only study we know where geriatric evaluation is actually used to guide treatment decisions. Then the other studies that we found basically used geriatric interventions to improve treatment outcomes and these have shown that at least there is an effect on treatment completion and also on treatment related complications but there is still limited data on effect on survival or quality of life or healthcare utilisation.

Would there be a reason to not do an assessment?

Yes, I agree, if we have the resources we should do an assessment but if we don’t look at the actual outcomes for the patient… So if we show that a geriatric assessment results in a change of treatment that’s interesting but it only shows me that the doctor has taken note of the results of the geriatric assessment. But if we don’t assess actual benefits then we don’t know if perhaps we get frightened by the results of the assessment and we are under-treating patients. So it’s really important and it was one of the things I also said in my talk this morning was that it’s really important that if we’re doing these kinds of studies we need to look at actual outcomes and actual benefits and not what I would call process indicators which just show us that something has changed in the process but we need to see if it actually changes the outcome.

Are there any plans to further examine this?

Yes, I think so. I didn’t go into the details of studies but when I looked at clinicaltrials.gov I found 15 ongoing studies which in their title had geriatric assessment including outcome and management. So in the next few years we can expect more data on this.

Do the amount of time and resources available vary significantly in your experience? 

Yes, definitely. There was a very interesting discussion yesterday in one of the sessions about how do we implement the geriatric assessment and you can see it ranges from nothing at all to a very simple screening to a geriatric assessment that is limited to a few geriatric domains to a full comprehensive geriatric assessment which incorporates also management and follow-up and multidisciplinarity. It varies with how motivated the team is, the resources that are available in the practical sense of time, money but also if you want to do a geriatric consultation you’ll need a geriatrician. It was also shown in one of the talks yesterday that, for example in the United States, they have about a tenth of the geriatricians that they expect to need within the next few years with the aging of society. So it really depends on what’s possible, on how you can implement this.

Should geriatricians reconsider doing an assessment if they were planning to?

No, I think we’ve shown the effects. The discussion is really now in fine-tuning how do we optimally implement it, what’s the best way. There will always be limited resources so what is the best way to use these resources, where should we place them. But I don’t think there is any debate, especially not here, that there is value in doing some form of geriatric screening or assessment.