Geriatric Assessments Can Improve Shared Decision Making, Patient Satisfaction
As people age, their risk for cancer increases, and so too does the complexity of their cancer care. Older patients with cancer typically present with age-related conditions like comorbidities, functional problems, falling, and polypharmacy, which are not as widely discussed in the oncology space as they should be. Age-
related concerns can influence outcomes for patients with cancer and their caregivers, including treatment toxicity, hospitalization, and even early mortality.
To have appropriate shared decision-making treatment conversations, providers, patients, and caregivers need to be on the same page about where patients are and how healthy and able they feel they are to tolerate forms of treatment. Using a validated geriatric assessment (GA) to support care can help uncover health conditions that could negatively affect treatment and outcomes.
In a Patient-Centered Outcomes Research Institute- and National Cancer Institute-funded study, when GAs and GA-based intervention recommendations were included in practice, it increased the frequency and quality of discussions about age-related concerns, the use of interventions for age-related conditions, and overall patient and caregiver satisfaction. An accompanying algorithm developed for the GA provided recommendations based on the information collected to help inform treatment discussions and potential interventions.
The American Society of Clinical Oncology guidelines for geriatric oncology include the use of GA in practice, and the University of Rochester has started offering GA to older patients with cancer to great effect. To spread the use of GA in practice, advance practice RNs and oncology nurses are key. Nurses can help facilitate vital conversations about treatments, side effects, symptom management, and patient-
centered decision making through the information the GA collects.
Older patients with cancer are at risk for being both undertreated and overtreated because of a lack of awareness about age-related conditions. Moreover, older patients are often excluded from large clinical trials because of comorbidities or other factors, leaving a limited evidence base for their clinical management.
Ultimately, proper care for geriatric patients with cancer must include interprofessional collaboration that uses a shared decision-making approach to ensure their best possible care. Use of a GA is just one way to specifically address the challenges that practitioners encounter in treating older adults to help close the gaps in care.