Geriatric Assessment: ASCO Global Guideline

ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO Guidelines Methodology Manual, ASCO Guidelines follow the ASCO Conflict of Interest Policy for Clinical Practice Guidelines. Clinical Practice Guidelines and other guidance (“Guidance”) provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases or stages of diseases. Guidance is based on review and analysis of relevant literature, and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in Appendix 1 for more. PURPOSE To guide clinicians and policymakers in global resource-constrained settings to assess the geriatric needs of patients older than 65 years with cancer when Maximal-setting guideline–recommended resources are unavailable. METHODS A multidisciplinary, multinational Expert Panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes. RESULTS An ASCO resource-neutral guideline was adapted for resource-constrained settings, informing one round of formal consensus; recommendations received ≥75% agreement. RECOMMENDATIONS The Expert Panel endorses the Maximal-setting guideline’s overarching recommendation that end users utilize geriatric assessment (GA), including essential domains, to identify “vulnerabilities or impairments not routinely captured in oncology assessment for all older patients over 65 years old with cancer.” All care plans for patients with cancer over 65 years old receiving systemic therapy with GA-identified deficits should include GA-guided management. A geriatric evaluation should at a minimum include the use of a brief geriatric screening tool. Tools in the Practical Geriatric Assessment (PGA) are validated in multiple languages, but users may use more appropriate tools in some settings and languages, if they include the relevant guideline-specified domains. Maximal-resource settings of high-income countries have traditionally developed cutoffs for GA-identified deficits, but locally validated research and practice may inform differing cutoffs. If validated all-cause mortality prognosis tools do not adequately represent the setting, clinicians may use actuarial life-expectancy tables with quartiles of overall health status. Additional information can be found at www.asco.org/global-guidelines. It is the view of ASCO that health care clinicians and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.