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Geriatric assessment in the management of older patients with cancer – A systematic review (update)

Open AccessPublished:May 08, 2022DOI:https://doi.org/10.1016/j.jgo.2022.04.008

      Abstract

      Aim

      The aim of this systematic review is to summarize all available data on the effect of a geriatric assessment in older patients with cancer, for oncologic treatment decisions, the implementation of non-oncologic interventions, patient-doctor communication, and treatment outcome. Additionally, we examined the impact of the type of assessment used.

      Methods

      Systematic Medline and Embase search for studies on the effect of a geriatric assessment on oncologic treatment decisions, non-oncologic interventions, communication, and outcome.

      Results

      Sixty-five publications from 61 studies were included. After a geriatric assessment, the oncologic treatment plan was altered in a median of 31% of patients (range 7–56%), with highest change rates in studies using a multidisciplinary team evaluation. Non-oncologic interventions were recommended in over 70% of patients, provided that an intervention plan or specific expertise was in place. A geriatric assessment led to more goals-of-care discussions and improved communication. The geriatric assessment also led to lower toxicity/complication rates (most strongly if the assessment outcomes were considered during decision making), improved likelihood of treatment completion, and improved physical functioning and quality of life in the majority of included studies.

      Conclusion

      A geriatric assessment can change oncologic treatment plans, leads to non-oncologic interventions, and improve communication about care planning and ageing-related issues. It can decrease toxicity/complications and improve treatment completion and patient-centred outcomes. If multidisciplinary or geriatric input is not available, having a pre-defined non-oncologic intervention plan is important. To maximize the effect on outcomes, the result of the geriatric assessment should be incorporated into oncologic decision-making.

      Keywords

      1. Introduction

      Cancer mostly affects older adults, and the dilemma of the best treatment for this disease in older patients led to the emergence of the field of geriatric oncology over 25 years ago [
      • Monfardini S.
      • Balducci L.
      • Overcash J.
      • Aapro M.
      Landmarks in geriatric oncology.
      ]. Early research focused on demonstrating the heterogeneity in the older population, highlighting that this was insufficiently captured by performance status as included in a standard oncologic workup [
      • Hamaker M.E.
      • Prins M.C.
      • Stauder R.
      The relevance of a geriatric assessment for elderly patients with a haematological malignancy - A systematic review.
      ]. Next, the concept of frailty was adopted and evaluated with a geriatric assessment – a multidimensional assessment of health status across somatic, functional, and psychosocial domains that is routinely used in geriatric medicine. This led to studies consistently demonstrating an association between baseline geriatric impairments, frailty, and various adverse outcomes, including complications, toxicity, and mortality, across various cancer and treatment types [
      • Hamaker M.E.
      • te Molder M.
      • Thielen N.
      • van Munster B.C.
      • Schiphorst A.H.
      • van Huis L.H.
      The effect of a geriatric assessment on treatment decisions and outcome for older cancer patients – A systematic review.
      ].
      In a systematic review on the effect of a geriatric assessment for the care of older patients with cancer published in 2018 in the Journal of Geriatric Oncology [
      • Hamaker M.E.
      • te Molder M.
      • Thielen N.
      • van Munster B.C.
      • Schiphorst A.H.
      • van Huis L.H.
      The effect of a geriatric assessment on treatment decisions and outcome for older cancer patients – A systematic review.
      ], we demonstrated that performing a geriatric assessment could alter oncologic treatment decisions in older adults with cancer and provide opportunities for non-oncologic management [
      • Hamaker M.E.
      • te Molder M.
      • Thielen N.
      • van Munster B.C.
      • Schiphorst A.H.
      • van Huis L.H.
      The effect of a geriatric assessment on treatment decisions and outcome for older cancer patients – A systematic review.
      ]. Despite these emerging data, implementation of a geriatric assessment into clinical practice has been slow [
      • To T.H.M.
      • Soo W.K.
      • Lane H.
      • et al.
      Utilisation of geriatric assessment in oncology - a survey of Australian medical oncologists.
      ]. A possible explanation could be that these studies demonstrated that a geriatric assessment led clinicians to change the oncological care they provided for their patients, but evidence that this ultimately improves outcomes that are meaningful to both patients and clinicians was lacking at that time [
      • Hamaker M.E.
      • te Molder M.
      • Thielen N.
      • van Munster B.C.
      • Schiphorst A.H.
      • van Huis L.H.
      The effect of a geriatric assessment on treatment decisions and outcome for older cancer patients – A systematic review.
      ]. Since 2018, several clinical trials with landmark potential have been published in the field of geriatric oncology. These have compared outcomes for older patients with cancer who underwent a geriatric assessment – with or without subsequent interventions – to the outcomes in a control group without geriatric assessment and/or follow-up. They represent an important missing piece in the framework of geriatric oncology.
      Another question still open to debate is the best way of organising the geriatric assessment in daily practice. Studies have used a range of methods including a geriatric consultation, a questionnaire-based assessment of geriatric domains by a health care professional from the oncology team, or a multidisciplinary team evaluation [
      • Wildiers H.
      • Heeren P.
      • Puts M.
      • et al.
      International society of geriatric oncology consensus on geriatric assessment in older patients with cancer.
      ]. Some studies take the outcome of the geriatric assessment into account during oncologic decision-making, while others use the assessment primarily for implementing non-oncologic interventions, with or without a pre-defined intervention plan. This choice could be based purely on pragmatism in relation to local circumstances and resources, but in some situations, multiple options for organising the geriatric assessment and subsequent care process may be feasible. As more data have become available since the previous systematic review, it may now be possible to compare these options with regards to the potential impact on decision-making and the subsequent care trajectory. We therefore felt that an update of the 2018 systematic review was warranted.
      The aim of this systematic review was to summarize currently available data on the effect of a geriatric assessment on the treatment of older patients with cancer for oncologic treatment decisions, the implementation of non-oncologic interventions, doctor-patient communication, and the impact on treatment outcome. A second aim was to assess differences in impact based on the way the geriatric assessment is implemented.

      2. Methods

      2.1 Search strategy and article selection

      For this systematic review, ethics review was not required. The following search was performed on December 16, 2021 in both Medline and Embase: (frailty[tiab] OR frail[tiab] OR geriatrics[MeSH] OR “Geriatric Assessment”[MeSH] OR geriatric*[tiab] OR elderly care[tiab] OR elderly medicine[tiab]) AND (neoplasm[MeSH] OR cancer[tiab] OR tumour[tiab] OR tumour[tiab] OR tumours[tiab] OR tumours[tiab] OR neoplasm[tiab] OR malignan*[tiab] OR oncol*) AND (multidisciplin*[tiab] OR interdisciplin*[tiab] OR team*[tiab] OR tumour board*[tiab] OR tumour board*[tiab] OR conference*[tiab] OR meeting*[tiab] OR decision*[tiab] OR decision making[tiab] OR decision-making[tiab] OR treatment choice*[tiab] OR intervention*[tiab] OR management[tiab] OR prehabilitation[tiab] OR communication[tiab] OR discussions[tiab] OR conversation*[tiab]). MeSH refers to medical subheading, tiab refers to title and abstract. As this was an update of an earlier search, publication date was truncated at December 2017. No limits in age or language were applied.
      For this systematic review, a geriatric assessment could consist of a geriatric consultation, an assessment by the oncology team, or a multidisciplinary team evaluation. We defined a geriatric consultation (C) as a consultation with a geriatrician or specialist in elderly medicine. An assessment by the oncology team (O) was defined as a questionnaire-based assessment performed by a cancer specialist or a health care provider (such as a nurse) working with the cancer specialist, focussing on at least three geriatric domains (cognition, mood/depression, nutritional status, activities of daily living, instrumental activities of daily living, comorbidity, polypharmacy, mobility/falls, or frailty), investigated with validated assessment tools. A multidisciplinary team evaluation (M) was defined as an assessment of at least three geriatric domains performed by two or more (para)medical health care professionals (e.g., physiotherapist, nutritionist, social worker).
      Studies were included if they fulfilled the inclusion criteria for one or more of four outcome measures. The first outcome measure was any alteration in oncologic treatment plan after the geriatric assessment. For this outcome measure, studies were included if a treatment plan was determined both prior to and after the geriatric assessment or if a comparison was made between treatment choice in patient cohorts with and without a geriatric assessment. The second outcome measure was the number and type of recommendations for non-oncologic interventions directly resulting from the findings of the geriatric assessment. The third outcome measure was the effect of the geriatric assessment on patient-doctor communication, for example differences in the content of doctor-patient conversations, care planning, or patient satisfaction with the communication process. The final outcome measure was the effect of the geriatric assessment on outcome of treatment, i.e., toxicity or treatment-related complications, treatment completion, quality of life or physical functioning, mortality, and health care utilisation (such as hospitalisation, length of stay). For both effect on communication and on outcome of treatment, studies were only included if they had a control group which did not undergo a geriatric assessment, and/or if the study had a control group that did not receive geriatric interventions or follow-up whilst the intervention group did. The control groups had to be either based on randomisation or historic/matched cohorts. Studies using a control group that was likely to be subject to confounding or selection bias were excluded (for example, if only vulnerable patients were referred for a geriatric assessment and the control group consisted of non-vulnerable patients). These studies could still be included for other outcome measures.
      The titles and abstracts of all studies retrieved by the search were assessed by one reviewer (MH) to determine which warranted further examination. All potentially relevant articles were subsequently screened as full text by two authors (MH and CL/SR). Studies were excluded if they were not written in English or Dutch. If only an abstract was available, an effort was made to find the final report of the study by searching Embase and Medline using the names of the first, second, and/or final author as well as key words from the title. If multiple publications were available from one study, the primary publication was included. If a secondary manuscript contained relevant outcomes that were not included in the primary publication, both were included together. Finally, references of included publications were cross-referenced to retrieve any additional relevant citations.
      In addition, all studies from the 2018 systematic review [
      • Hamaker M.E.
      • te Molder M.
      • Thielen N.
      • van Munster B.C.
      • Schiphorst A.H.
      • van Huis L.H.
      The effect of a geriatric assessment on treatment decisions and outcome for older cancer patients – A systematic review.
      ] were checked to assure that the most recent/complete version was included in the current review.

      2.2 Data extraction

      For each eligible study, the following data were independently extracted by two investigators (MH, CL): type of study, study setting, study population (age, sex, cancer type), method of patient selection, the type of control group if present, type of geriatric assessment, the frequency and types of changes in treatment after the geriatric assessment, the number and type of (recommended) non-oncologic interventions, whether or not the study used a pre-defined protocol for non-oncologic interventions, changes in communication/care planning, and finally, the change in treatment outcomes, i.e., toxicity or treatment-related complications, treatment completion, quality of life or physical functioning, mortality, and health care utilisation (hospitalisation, readmissions, length of stay). For studies assessing change in treatment outcomes, we also extracted whether or not the geriatric assessment was taken into account during oncologic treatment decisions, and whether or not the study included interventions or follow-up with regards to geriatric impairments highlighted by the geriatric assessment.

      2.3 Quality assessment

      The methodological quality of each of the studies was independently assessed by two reviewers (MH, CL), using the Newcastle-Ottawa Scale adapted to this subject (Appendix 1a) [

      Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis.

      ]. Disagreement among the reviewers was discussed during a consensus meeting.

      2.4 Data synthesis and analysis

      We summarized the study results to describe our main outcomes of interest. Data on the proportion of patients for whom the oncologic treatment plan was changed after a geriatric assessment, and on the proportion of patients with one or more non-oncologic recommendations, were pooled according to the three models of geriatric assessment: geriatric consultation, assessment by the oncology team performed by a cancer specialist or a health care provider working with the cancer specialist, or multidisciplinary team evaluation, as detailed in the section on study selection. Organisation parameters were presence/absence of a predefined intervention plan, and whether the outcome of the assessment was included in the decision making. Pooled data were subsequently compared using a validated online chi-square calculator [].
      For studies assessing treatment outcomes and course of treatment, intervention methodology was too heterogenous to permit pooling of data; descriptive statistics were used instead. To account for the potential impact effect of study size and possible power issues with regards to outcomes, sensitivity analyses using descriptive statistics were performed to assess subgroups based on the size of the study population (above or below the median study size).

      3. Results

      3.1 Study characteristics

      The 2021 literature search identified 5202 citations (1758 from Medline and 3444 from Embase), of which 1243 were duplicates. Details on the search and reasons for exclusion can be found in Fig. 1. After exclusion of 3933 publications, 26 publications from 25 studies were included [
      • SA Alexander K.
      • SS K.G.B.
      Geriatric assessment in older cancer patients and its potential impact on surgical treatment decisions.
      ,
      • Bossi P.
      • Esposito A.
      • Vecchio S.
      • et al.
      Role of geriatric assessment in tailoring treatment of locally advanced head and neck cancer: the ELDERLY study.
      ,
      • Derman B.A.
      • Kordas K.
      • Ridgeway J.
      • et al.
      Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults.
      ,
      • Dougoud Chauvin V.
      • Szüts N.
      • Laszlo A.
      • Betticher D.C.
      A new oncogeriatric consultation: patient characteristics and the support installed demonstrating its need!.
      ,
      • DuMontier C.
      • Uno H.
      • Hshieh T.
      • et al.
      Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies.
      ,
      • Festen S.
      • Kok M.
      • Hopstaken J.S.
      • et al.
      How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study.
      ,
      • Garric M.
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      Impact of a comprehensive geriatric assessment on decision-making in older patients with hematological malignancies.
      ,
      • Giger A.K.W.
      • Nadaraja S.
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      • Thomsen K.
      • Matzen L.E.
      Most patients with cancer referred to comprehensive geriatric assessment are in need of geriatric intervention.
      ,
      • Gunaydin U.M.
      • Cincin A.T.
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      Analysis of feasibility of geriatric assessment tools in elderly cancer patients and effects on anti-cancer treatment planning.
      ,
      • Handforth C.
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      • Freeman J.
      • et al.
      Comprehensive geriatric assessment and decision-making in older men with incurable but manageable (chronic) cancer.
      ,
      • Jolly T.A.
      • Deal A.M.
      • Mariano C.
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      A randomized trial of real-time geriatric assessment reporting in nonelectively hospitalized older adults with Cancer.
      ,
      • Kenis C.
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      Adherence to geriatric assessment-based recommendations in older patients with cancer: A multicenter prospective cohort study in Belgium.
      ,
      • Li D.
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      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ,
      • Lola C.
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      • Elias A.
      • et al.
      Geriatric assessment in decision-making process in older patients with breast cancer: the ELCAPA cohort study.
      ,
      • Lund C.M.
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      The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO).
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      • Mohile S.G.
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      Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
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      • Mohile S.G.
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      Communication with older patients with Cancer using geriatric assessment: A cluster-randomized clinical trial from the National Cancer Institute Community oncology research program.
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      Geriatric assessment in older people with myelodysplasia is predictive of azacitidine therapy completion and survival: A prospective interventional study at the royal Adelaide hospital.
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      The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial.
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      • Ørum M.
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      The impact of a tailored follow-up intervention on comprehensive geriatric assessment in older patients with cancer - a randomised controlled trial.
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      • Ørum M.
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      Impact of comprehensive geriatric assessment on short-term mortality in older patients with cancer—a follow-up study.
      ,
      • Plana M.
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      Impact of geriatric assessment on the management of older head and neck cancer patients.
      ,
      • Santos G.H.
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      Effect of a geriatric management unit on the outcomes of hospitalized older adults with cancer in Mexico.
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      Implementation of a preoperative multidisciplinary team approach for frail colorectal cancer patients: influence on patient selection, prehabilitation and outcome.
      ,
      • Wang M.
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      CGA directed interventions in Asian geriatric oncology patients.
      ,
      • Almugbel F.
      Role of the vulnerable elders survey-13 screening tool in predicting treatment plan modification for older adults with cancer.
      ]. Cross-referencing yielded one additional result [
      • Soo W.-K.
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      • et al.
      Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy.
      ]. From the 2018 systematic review [
      • Hamaker M.E.
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      • van Munster B.C.
      • Schiphorst A.H.
      • van Huis L.H.
      The effect of a geriatric assessment on treatment decisions and outcome for older cancer patients – A systematic review.
      ], 36 publications from 35 studies were included [
      • Aliamus V.
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      Geriatric assessment contribution to treatment decision-making in thoracic oncology.
      ,
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      Feasibility of integrating comprehensive geriatric assessment-driven interventions into standard oncology practice in real time.
      ,
      • Aparicio T.
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      • Legrain S.
      • Soulé J.C.
      A mini geriatric assessment helps treatment decision in elderly patients with digestive cancer. A pilot study.
      ,
      • Bastos-Oreiro M.
      • Rodriguez-Macias G.
      • Pradillo V.
      • et al.
      A prospective study to evaluate the utility of geriatric assessment and intervetnion in patients with lymphoproliferative disorders in a tertiary hospital.
      ,
      • Blanco R.
      • Capo M.
      • Libran A.M.
      • et al.
      Multidisciplinary treatment planning in elderly patients with cancer: A prospective observational study.
      ,
      • Boulahssass R.
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      • Isabelle B.
      • et al.
      Influence of the comprehensive geriatric assessment (CGA) in elderly metastatic cancer patients. Analysis from a prospective cohort of 1048 patients.
      ,
      • Caillet P.
      • Canoui-Poitrine F.
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      • et al.
      Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
      ,
      • Chaïbi P.
      • Magné N.
      • Breton S.
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      Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.
      ,
      • Chapman A.E.
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      Development of a comprehensive multidisciplinary geriatric oncology center, the Thomas Jefferson university experience.
      ,
      • Corre R.
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      • le Caër H.
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      Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small cell lung cancer: the Phase III randomized ESOGIA-GFPC-GECP 08-02 Study.
      ,
      • Extermann M.
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      A comprehensive geriatric intervention detects multiple problems in older breast cancer patients.
      ,
      • Fletcher J.
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      Assessing treatment tolerability after geriatric assessment in the senior oncology clinic at the gold coast university hospital.
      ,

      Frennet M Kjcphylv de SHM Impact of comprehensive geriatric assessment (CGA) during oncologic treatment in frail elderly patients. Eur Geriatric Med 2011;(2):S35.

      ,
      • Girre V.
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      Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?.
      ,
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      Long term outcomes of a geriatric liaison intervention in frail elderly cancer patients.
      ,
      • Hempenius L.
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      • van Leeuwen B.L.
      Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly Cancer patients: report on a multicentre, randomized, controlled trial.
      ,
      • Ho M.F.
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      • et al.
      A randomized controlled clinical trial to assess the impact of enhanced geriatric input on elderly patients undergoing colorectal cancer surgery.
      ,
      • Horgan A.M.
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      Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: A pilot study.
      ,
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      Multidisciplinary risk assessment to reveal cancer treatments in complex cancer patients.
      ,
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      Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice.
      ,
      • Kalsi T.
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      The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
      ,
      • Kenis C.
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      Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study.
      ,
      • Magnuson A.
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      Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study.
      ,
      • Mak T.
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      A pilot study of enhanced geriatric input in management of elderly patients undergoing colorectal cancer surgery.
      ,
      • Mertens C.
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      The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use by oncologists to classify patients as fit or unfit.
      ,
      • Odetto D.
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      Impact of a geriatric consultation in the decision making process for patients with gynecological cancer.
      ,
      • Ommundsen N.
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      Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial.
      ,
      • Palicio C.
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      Comprehensive geriatric assessment and intervention proposal in an outpatient hematology ward.
      ,

      Pattinson J. SA, CA, MT, MR. Does comprehensive geriatric assessment affect decision-making & outcomes for older adults treated for upper gastro-intestinal cancer. Eur Geriatric Med 2016;7:S101.

      ,
      • Puts M.T.E.
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      • Kulik M.
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      A randomized phase II trial of geriatric assessment and management for older cancer patients.
      ,
      • Rao A.
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      ,
      • Bugat M.E.R.
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      • Balardy L.
      • et al.
      Impact of an oncogeriatric consulting team on therapeutic decision-making.
      ,
      • Schiphorst A.H.W.
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      • Breumelhof R.
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      • Pronk A.
      • Hamaker M.E.
      Geriatric consultation can aid in complex treatment decisions for elderly cancer patients.
      ,
      • Schulkes K.J.G.
      • Souwer E.T.D.
      • Hamaker M.E.
      • et al.
      The effect of A geriatric assessment on treatment decisions for patients with lung Cancer.
      ,
      • Singh S.H.R.
      • SD, MK.
      Perioperative comprehensive geriatric assessment is associated with reduced inpatient length of stay.
      ,
      • Weltermann A.K.H.
      Diagnostic yield of a Geriatric assessment and a standardized intervention plan in elderly patients with newly diagnosed cancer: A cohort study.
      ]. The new literature search yielded updates [
      • Sattar S.
      • Alibhai S.M.H.
      • Brennenstuhl S.
      • et al.
      Health status, emergency department visits, and oncologists’ feedback: an analysis of secondary endpoints from a randomized phase II geriatric assessment trial.
      ,
      • Decoster L.
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      The influence of clinical assessment (including age) and geriatric assessment on treatment decisions in older patients with cancer.
      ] with new information for two of these 35 studies, which were also included. Thus, the combined result of the 2018 review and the 2021 update was 65 publications from 61 studies (Fig. 1) [
      • SA Alexander K.
      • SS K.G.B.
      Geriatric assessment in older cancer patients and its potential impact on surgical treatment decisions.
      ,
      • Bossi P.
      • Esposito A.
      • Vecchio S.
      • et al.
      Role of geriatric assessment in tailoring treatment of locally advanced head and neck cancer: the ELDERLY study.
      ,
      • Derman B.A.
      • Kordas K.
      • Ridgeway J.
      • et al.
      Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults.
      ,
      • Dougoud Chauvin V.
      • Szüts N.
      • Laszlo A.
      • Betticher D.C.
      A new oncogeriatric consultation: patient characteristics and the support installed demonstrating its need!.
      ,
      • DuMontier C.
      • Uno H.
      • Hshieh T.
      • et al.
      Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies.
      ,
      • Festen S.
      • Kok M.
      • Hopstaken J.S.
      • et al.
      How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study.
      ,
      • Garric M.
      • Sourdet S.
      • Cabarrou B.
      • et al.
      Impact of a comprehensive geriatric assessment on decision-making in older patients with hematological malignancies.
      ,
      • Giger A.K.W.
      • Nadaraja S.
      • Jeppesen S.S.
      • Thomsen K.
      • Matzen L.E.
      Most patients with cancer referred to comprehensive geriatric assessment are in need of geriatric intervention.
      ,
      • Gunaydin U.M.
      • Cincin A.T.
      • Gunaydin S.
      • et al.
      Analysis of feasibility of geriatric assessment tools in elderly cancer patients and effects on anti-cancer treatment planning.
      ,
      • Handforth C.
      • Burkinshaw R.
      • Freeman J.
      • et al.
      Comprehensive geriatric assessment and decision-making in older men with incurable but manageable (chronic) cancer.
      ,
      • Jolly T.A.
      • Deal A.M.
      • Mariano C.
      • et al.
      A randomized trial of real-time geriatric assessment reporting in nonelectively hospitalized older adults with Cancer.
      ,
      • Kenis C.
      • Decoster L.
      • Flamaing J.
      • et al.
      Adherence to geriatric assessment-based recommendations in older patients with cancer: A multicenter prospective cohort study in Belgium.
      ,
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ,
      • Lola C.
      • Emmanuelle B.
      • Elias A.
      • et al.
      Geriatric assessment in decision-making process in older patients with breast cancer: the ELCAPA cohort study.
      ,
      • Lund C.M.
      • Vistisen K.K.
      • Olsen A.P.
      • et al.
      The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO).
      ,
      • Mohile S.G.
      • Mohamed M.R.
      • Xu H.
      • et al.
      Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
      ,
      • Mohile S.G.
      • Epstein R.M.
      • Hurria A.
      • et al.
      Communication with older patients with Cancer using geriatric assessment: A cluster-randomized clinical trial from the National Cancer Institute Community oncology research program.
      ,
      • Molga A.
      • Wall M.
      • Chhetri R.
      • et al.
      Geriatric assessment in older people with myelodysplasia is predictive of azacitidine therapy completion and survival: A prospective interventional study at the royal Adelaide hospital.
      ,
      • Nadaraja S.
      • Matzen L.E.
      • Jørgensen T.L.
      • et al.
      The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial.
      ,
      • Ørum M.
      • Eriksen S.V.
      • Gregersen M.
      • et al.
      The impact of a tailored follow-up intervention on comprehensive geriatric assessment in older patients with cancer - a randomised controlled trial.
      ,
      • Ørum M.
      • Jensen K.
      • Gregersen M.
      • Meldgaard P.
      • Damsgaard E.M.
      Impact of comprehensive geriatric assessment on short-term mortality in older patients with cancer—a follow-up study.
      ,
      • Plana M.
      • Taberna M.
      • Llop S.
      • et al.
      Impact of geriatric assessment on the management of older head and neck cancer patients.
      ,
      • Santos G.H.
      • de la O Murillo A, de Celis ESP.
      Effect of a geriatric management unit on the outcomes of hospitalized older adults with cancer in Mexico.
      ,
      • van der Vlies E.
      • Smits A.B.
      • Los M.
      • et al.
      Implementation of a preoperative multidisciplinary team approach for frail colorectal cancer patients: influence on patient selection, prehabilitation and outcome.
      ,
      • Wang M.
      • Ho F.
      • Ng Y.S.
      • Tai B.C.
      • Yong W.C.
      • Pang S.L.A.
      CGA directed interventions in Asian geriatric oncology patients.
      ,
      • Almugbel F.
      Role of the vulnerable elders survey-13 screening tool in predicting treatment plan modification for older adults with cancer.
      ,
      • Soo W.-K.
      • King M.
      • Pope A.
      • Parente P.
      • Darzins P.
      • Davis I.D.
      • et al.
      Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy.
      ,
      • Aliamus V.
      • Adam C.
      • Druet-Cabanac M.
      • Dantoine T.
      • Vergnenegre A.
      Geriatric assessment contribution to treatment decision-making in thoracic oncology.
      ,
      • Andreozzi J.
      • Dale W.
      • Fan L.
      • Mohile S.
      Feasibility of integrating comprehensive geriatric assessment-driven interventions into standard oncology practice in real time.
      ,
      • Aparicio T.
      • Girard L.
      • Bouarioua N.
      • Patry C.
      • Legrain S.
      • Soulé J.C.
      A mini geriatric assessment helps treatment decision in elderly patients with digestive cancer. A pilot study.
      ,
      • Bastos-Oreiro M.
      • Rodriguez-Macias G.
      • Pradillo V.
      • et al.
      A prospective study to evaluate the utility of geriatric assessment and intervetnion in patients with lymphoproliferative disorders in a tertiary hospital.
      ,
      • Blanco R.
      • Capo M.
      • Libran A.M.
      • et al.
      Multidisciplinary treatment planning in elderly patients with cancer: A prospective observational study.
      ,
      • Boulahssass R.
      • Gonfrier S.
      • Isabelle B.
      • et al.
      Influence of the comprehensive geriatric assessment (CGA) in elderly metastatic cancer patients. Analysis from a prospective cohort of 1048 patients.
      ,
      • Caillet P.
      • Canoui-Poitrine F.
      • Vouriot J.
      • et al.
      Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
      ,
      • Chaïbi P.
      • Magné N.
      • Breton S.
      • et al.
      Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.
      ,
      • Chapman A.E.
      • Swartz K.
      • Schoppe J.
      • Arenson C.
      Development of a comprehensive multidisciplinary geriatric oncology center, the Thomas Jefferson university experience.
      ,
      • Corre R.
      • Greillier L.
      • le Caër H.
      • et al.
      Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small cell lung cancer: the Phase III randomized ESOGIA-GFPC-GECP 08-02 Study.
      ,
      • Extermann M.
      • Meyer J.
      • McGinnis M.
      • et al.
      A comprehensive geriatric intervention detects multiple problems in older breast cancer patients.
      ,
      • Fletcher J.
      • Sanmugarajah J.
      • Caird S.
      • Allen M.
      • Quennell A.
      • Powell M.
      Assessing treatment tolerability after geriatric assessment in the senior oncology clinic at the gold coast university hospital.
      ,

      Frennet M Kjcphylv de SHM Impact of comprehensive geriatric assessment (CGA) during oncologic treatment in frail elderly patients. Eur Geriatric Med 2011;(2):S35.

      ,
      • Girre V.
      • Falcou M.C.
      • Gisselbrecht M.
      • et al.
      Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?.
      ,
      • Hempenius L.
      • Slaets J.P.J.
      • van Asselt D.
      • de Bock T.H.
      • Wiggers T.
      • van Leeuwen B.L.
      Long term outcomes of a geriatric liaison intervention in frail elderly cancer patients.
      ,
      • Hempenius L.
      • Slaets J.P.J.
      • van Asselt D.
      • de Bock G.H.
      • Wiggers T.
      • van Leeuwen B.L.
      Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly Cancer patients: report on a multicentre, randomized, controlled trial.
      ,
      • Ho M.F.
      • Dai D.L.K.
      • Lee J.F.Y.
      • et al.
      A randomized controlled clinical trial to assess the impact of enhanced geriatric input on elderly patients undergoing colorectal cancer surgery.
      ,
      • Horgan A.M.
      • Leighl N.B.
      • Coate L.
      • et al.
      Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: A pilot study.
      ,
      • Huillard O.
      • Boudou-Rouquette P.
      • Chahwakilian A.
      • et al.
      Multidisciplinary risk assessment to reveal cancer treatments in complex cancer patients.
      ,
      • Hurria A.
      • Lichtman S.M.
      • Gardes J.
      • et al.
      Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice.
      ,
      • Kalsi T.
      • Babic-Illman G.
      • Ross P.J.
      • et al.
      The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
      ,
      • Kenis C.
      • Bron D.
      • Libert Y.
      • et al.
      Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study.
      ,
      • Magnuson A.
      • Lemelman T.
      • Pandya C.
      • et al.
      Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study.
      ,
      • Mak T.
      • Dal D.
      • Wa Leung W.
      • Lee J.
      • Ng S.
      A pilot study of enhanced geriatric input in management of elderly patients undergoing colorectal cancer surgery.
      ,
      • Mertens C.
      • le Caer H.
      • Ortholan C.
      • et al.
      The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use by oncologists to classify patients as fit or unfit.
      ,
      • Odetto D.
      • Smietniansky M.
      • Noll F.
      • Boietti B.
      • Perrotta M.
      Impact of a geriatric consultation in the decision making process for patients with gynecological cancer.
      ,
      • Ommundsen N.
      • Wyller T.B.
      • Nesbakken A.
      • et al.
      Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial.
      ,
      • Palicio C.
      • Boqué C.
      • Antonio M.
      • Bidó M.
      Comprehensive geriatric assessment and intervention proposal in an outpatient hematology ward.
      ,

      Pattinson J. SA, CA, MT, MR. Does comprehensive geriatric assessment affect decision-making & outcomes for older adults treated for upper gastro-intestinal cancer. Eur Geriatric Med 2016;7:S101.

      ,
      • Puts M.T.E.
      • Sattar S.
      • Kulik M.
      • et al.
      A randomized phase II trial of geriatric assessment and management for older cancer patients.
      ,
      • Rao A.
      • v., Hsieh F, Feussner JR, Cohen HJ.
      Geriatric assessment and management units in the care of the frail elderly cancer patient.
      ,
      • Bugat M.E.R.
      • Gerard S.
      • Balardy L.
      • et al.
      Impact of an oncogeriatric consulting team on therapeutic decision-making.
      ,
      • Schiphorst A.H.W.
      • ten Bokkel Huinink D.
      • Breumelhof R.
      • Burgmans J.P.J.
      • Pronk A.
      • Hamaker M.E.
      Geriatric consultation can aid in complex treatment decisions for elderly cancer patients.
      ,
      • Schulkes K.J.G.
      • Souwer E.T.D.
      • Hamaker M.E.
      • et al.
      The effect of A geriatric assessment on treatment decisions for patients with lung Cancer.
      ,
      • Singh S.H.R.
      • SD, MK.
      Perioperative comprehensive geriatric assessment is associated with reduced inpatient length of stay.
      ,
      • Weltermann A.K.H.
      Diagnostic yield of a Geriatric assessment and a standardized intervention plan in elderly patients with newly diagnosed cancer: A cohort study.
      ,
      • Sattar S.
      • Alibhai S.M.H.
      • Brennenstuhl S.
      • et al.
      Health status, emergency department visits, and oncologists’ feedback: an analysis of secondary endpoints from a randomized phase II geriatric assessment trial.
      ,
      • Decoster L.
      • Kenis C.
      • van Puyvelde K.
      • et al.
      The influence of clinical assessment (including age) and geriatric assessment on treatment decisions in older patients with cancer.
      ].
      The characteristics of these 61 studies are summarized in Table 1. Twenty-eight studies used a geriatric consultation; 17 used an assessment by the oncology team, and in 16 studies the geriatric assessment was performed by a multidisciplinary team. The complete study population consisted of 16,819 patients, of which 74% were included in the studies published between 2018 and 2021. Median sample size was 123 patients (range 15–5631). Mean or median age of the patient populations ranged from 68 to 83 years. Study populations were heterogeneous, with 24 focusing on patients with a specific type of cancer, while the remainder included patients with various cancer types.
      Table 1Included studies.
      PublicationStudy methodPatientsOutcome
      AuthorPublication yearAbstract (A) or full text (F)Study populationPatient selectionNo. of patients% maleMe(di)an age in years (range)Change in cancer treatment planNon-oncologic interventionsEffect on communicationEffect on treatment outcome*
      Studies using a geriatric consultation performed by a geriatrician (C)
      Alexander [
      • SA Alexander K.
      • SS K.G.B.
      Geriatric assessment in older cancer patients and its potential impact on surgical treatment decisions.
      ]
      2018AVarious cancer typesAge ≥ 75 years, scheduled for surgery1767??X
      Almugbel [
      • Almugbel F.
      Role of the vulnerable elders survey-13 screening tool in predicting treatment plan modification for older adults with cancer.
      ]
      2021FVarious cancer types?38658%81.1 (6.3)X
      Aparicio [
      • Aparicio T.
      • Girard L.
      • Bouarioua N.
      • Patry C.
      • Legrain S.
      • Soulé J.C.
      A mini geriatric assessment helps treatment decision in elderly patients with digestive cancer. A pilot study.
      ]
      2011FVarious gastrointestinal cancersAge > 75 years2152%81(75–87)X
      Bossi [
      • Bossi P.
      • Esposito A.
      • Vecchio S.
      • et al.
      Role of geriatric assessment in tailoring treatment of locally advanced head and neck cancer: the ELDERLY study.
      ]
      2021AHead and neck cancerAge ≥ 65 years101??XX
      Caillet [
      • Caillet P.
      • Canoui-Poitrine F.
      • Vouriot J.
      • et al.
      Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
      ]
      2011FVarious cancer typesAge ≥ 70 years37547%80 (70–99)XX
      Chaibi [
      • Chaïbi P.
      • Magné N.
      • Breton S.
      • et al.
      Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.
      ]
      2011FVarious cancer typesAge ≥ 75 years16135%82 (73–97)XX
      Dougoud [
      • Dougoud Chauvin V.
      • Szüts N.
      • Laszlo A.
      • Betticher D.C.
      A new oncogeriatric consultation: patient characteristics and the support installed demonstrating its need!.
      ]
      2019A??11952%82 (?)X
      Dumontier [
      • DuMontier C.
      • Uno H.
      • Hshieh T.
      • et al.
      Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies.
      ]
      2021FHaematological malignanciesAge ≥ 75 years16065%80.4 (SD 4.2)XX
      Garric [
      • Garric M.
      • Sourdet S.
      • Cabarrou B.
      • et al.
      Impact of a comprehensive geriatric assessment on decision-making in older patients with hematological malignancies.
      ]
      2020FHaematological malignanciesAge ≥ 65 years, hospitalized42455%80 (65–99)X
      Giger [
      • Giger A.K.W.
      • Nadaraja S.
      • Jeppesen S.S.
      • Thomsen K.
      • Matzen L.E.
      Most patients with cancer referred to comprehensive geriatric assessment are in need of geriatric intervention.
      ]
      2020AVarious cancer types?9965%74 (IQR 53–88)X
      Hempenius [
      • Hempenius L.
      • Slaets J.P.J.
      • van Asselt D.
      • de Bock T.H.
      • Wiggers T.
      • van Leeuwen B.L.
      Long term outcomes of a geriatric liaison intervention in frail elderly cancer patients.
      ,
      • Hempenius L.
      • Slaets J.P.J.
      • van Asselt D.
      • de Bock G.H.
      • Wiggers T.
      • van Leeuwen B.L.
      Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly Cancer patients: report on a multicentre, randomized, controlled trial.
      ]
      2016FVarious cancer typesAge > 65 years, frail, planned for surgery26039%77 (SD 7)X
      Horgan [
      • Horgan A.M.
      • Leighl N.B.
      • Coate L.
      • et al.
      Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: A pilot study.
      ]
      2011FVarious cancer typesAge ≥ 70 years3057%78 (70–88)XX
      Kalsi [
      • Kalsi T.
      • Babic-Illman G.
      • Ross P.J.
      • et al.
      The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
      ]
      2015FVarious cancer typesAge ≥ 70 years13555%75 (70–90)XXX
      Lola [
      • Lola C.
      • Emmanuelle B.
      • Elias A.
      • et al.
      Geriatric assessment in decision-making process in older patients with breast cancer: the ELCAPA cohort study.
      ]
      2018ABreast cancerAge ≥ 70 years3020%81 (IQR 76–85)X
      Lund [
      • Lund C.M.
      • Vistisen K.K.
      • Olsen A.P.
      • et al.
      The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO).
      ]
      2021FColorectal cancerAge ≥ 70 years, starting chemotherapy14258%75 (70–88)XX
      Molga [
      • Molga A.
      • Wall M.
      • Chhetri R.
      • et al.
      Geriatric assessment in older people with myelodysplasia is predictive of azacitidine therapy completion and survival: A prospective interventional study at the royal Adelaide hospital.
      ]
      2018AHaematological malignancies?70??X
      Nadaraja [
      • Nadaraja S.
      • Matzen L.E.
      • Jørgensen T.L.
      • et al.
      The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial.
      ]
      2020FVarious cancer typesAge ≥ 70 years9652%76 (70–87)XX
      Ommundsen [
      • Ommundsen N.
      • Wyller T.B.
      • Nesbakken A.
      • et al.
      Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial.
      ]
      2017FColorectal cancerAge > 65 years, planned for surgery12251%79 (SD 7)XX
      Orum [
      • Ørum M.
      • Eriksen S.V.
      • Gregersen M.
      • et al.
      The impact of a tailored follow-up intervention on comprehensive geriatric assessment in older patients with cancer - a randomised controlled trial.
      ]
      2021FVarious cancer typesAge ≥ 70 years30155%75 (72–79)X
      Orum [
      • Ørum M.
      • Jensen K.
      • Gregersen M.
      • Meldgaard P.
      • Damsgaard E.M.
      Impact of comprehensive geriatric assessment on short-term mortality in older patients with cancer—a follow-up study.
      ]
      2019FVarious cancer typesAge ≥ 70 years40755%76 (IQR 72–80)X
      Palicio [
      • Palicio C.
      • Boqué C.
      • Antonio M.
      • Bidó M.
      Comprehensive geriatric assessment and intervention proposal in an outpatient hematology ward.
      ]
      2017AHaematological malignanciesAge ≥ 75 years30?80X
      Plana [
      • Plana M.
      • Taberna M.
      • Llop S.
      • et al.
      Impact of geriatric assessment on the management of older head and neck cancer patients.
      ]
      2020AHead and neck cancerAge ≥ 70 years12470%80 (71–96)XX
      Puts [
      • Puts M.T.E.
      • Sattar S.
      • Kulik M.
      • et al.
      A randomized phase II trial of geriatric assessment and management for older cancer patients.
      ,
      • Sattar S.
      • Alibhai S.M.H.
      • Brennenstuhl S.
      • et al.
      Health status, emergency department visits, and oncologists’ feedback: an analysis of secondary endpoints from a randomized phase II geriatric assessment trial.
      ]
      2018FVarious cancer typesAge ≥ 70 years5867%75 (70-92)XX
      Rouge-Bugat [
      • Bugat M.E.R.
      • Gerard S.
      • Balardy L.
      • et al.
      Impact of an oncogeriatric consulting team on therapeutic decision-making.
      ]
      2013FVarious cancer typesAge ≥ 70 years, hospitalized10745%¥81 (IQR 75–85) ¥X
      Schiphorst [
      • Schiphorst A.H.W.
      • ten Bokkel Huinink D.
      • Breumelhof R.
      • Burgmans J.P.J.
      • Pronk A.
      • Hamaker M.E.
      Geriatric consultation can aid in complex treatment decisions for elderly cancer patients.
      ]
      2016FVarious cancer typesConsecutive referrals7242%82 (57–94)X
      Schulkes [
      • Schulkes K.J.G.
      • Souwer E.T.D.
      • Hamaker M.E.
      • et al.
      The effect of A geriatric assessment on treatment decisions for patients with lung Cancer.
      ]
      2017FLung cancerConsecutive referrals8365%79 (IQR 74–82)XX
      Singh [
      • Singh S.H.R.
      • SD, MK.
      Perioperative comprehensive geriatric assessment is associated with reduced inpatient length of stay.
      ]
      2015AGastrointestinal cancerPatients with frailty or multimorbidity???X
      Soo [
      • Soo W.-K.
      • King M.
      • Pope A.
      • Parente P.
      • Darzins P.
      • Davis I.D.
      • et al.
      Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy.
      ]
      2020AVarious cancer typesAge ≥ 70 years154??X
      Studies using a geriatric assessment performed by the cancer specialist/health care provider working with the cancer specialist (O)
      Aliamus [
      • Aliamus V.
      • Adam C.
      • Druet-Cabanac M.
      • Dantoine T.
      • Vergnenegre A.
      Geriatric assessment contribution to treatment decision-making in thoracic oncology.
      ]
      2011FLung cancerAge ≥ 70 years4780%79 (70–91)X
      Bastos-Oreiro [
      • Bastos-Oreiro M.
      • Rodriguez-Macias G.
      • Pradillo V.
      • et al.
      A prospective study to evaluate the utility of geriatric assessment and intervetnion in patients with lymphoproliferative disorders in a tertiary hospital.
      ]
      2017ALymphoproliferative disordersAge > 70 years26??X
      Blanco [
      • Blanco R.
      • Capo M.
      • Libran A.M.
      • et al.
      Multidisciplinary treatment planning in elderly patients with cancer: A prospective observational study.
      ]
      2016FVarious cancer typesAge ≥ 80 years or ≥ 70 years and frail6658%¥?X
      Boulahssass [
      • Boulahssass R.
      • Gonfrier S.
      • Isabelle B.
      • et al.
      Influence of the comprehensive geriatric assessment (CGA) in elderly metastatic cancer patients. Analysis from a prospective cohort of 1048 patients.
      ]
      2016AVarious cancer typesUnclear312?82 (?)X
      Corre [
      • Corre R.
      • Greillier L.
      • le Caër H.
      • et al.
      Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small cell lung cancer: the Phase III randomized ESOGIA-GFPC-GECP 08-02 Study.
      ]
      2016FNon-small cell lung cancerAge ≥ 70 years49474%77 (70–91)XX
      Festen [
      • Festen S.
      • Kok M.
      • Hopstaken J.S.
      • et al.
      How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study.
      ]
      2019FVarious cancer typesAge ≥ 70 years19756%78 (70–93)XX
      Frennet [

      Frennet M Kjcphylv de SHM Impact of comprehensive geriatric assessment (CGA) during oncologic treatment in frail elderly patients. Eur Geriatric Med 2011;(2):S35.

      ]
      2011AVarious cancer typesAge ≥ 70 years5342%¥79 (SD 5.9) ¥X
      Girre [
      • Girre V.
      • Falcou M.C.
      • Gisselbrecht M.
      • et al.
      Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?.
      ]
      2008FVarious cancer typesAge ≥ 70 years9317%¥79 (70–97)¥X
      Gunaydin [
      • Gunaydin U.M.
      • Cincin A.T.
      • Gunaydin S.
      • et al.
      Analysis of feasibility of geriatric assessment tools in elderly cancer patients and effects on anti-cancer treatment planning.
      ]
      2018AVarious cancer typesAge ≥ 65 years41??X
      Handforth [
      • Handforth C.
      • Burkinshaw R.
      • Freeman J.
      • et al.
      Comprehensive geriatric assessment and decision-making in older men with incurable but manageable (chronic) cancer.
      ]
      2019FVarious cancer typesAge ≥ 60 years48100%72 (62–94)X
      Jolly [
      • Jolly T.A.
      • Deal A.M.
      • Mariano C.
      • et al.
      A randomized trial of real-time geriatric assessment reporting in nonelectively hospitalized older adults with Cancer.
      ]
      2020FVarious cancer typesAge ≥ 70 years, hospitalized13548%76 (70–92)X
      Kenis [
      • Kenis C.
      • Decoster L.
      • Flamaing J.
      • et al.
      Adherence to geriatric assessment-based recommendations in older patients with cancer: A multicenter prospective cohort study in Belgium.
      ]
      2018FVarious cancer typesAge ≥ 70 years563146%78 (70–101)X
      Kenis [
      • Kenis C.
      • Bron D.
      • Libert Y.
      • et al.
      Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study.
      ,
      • Decoster L.
      • Kenis C.
      • van Puyvelde K.
      • et al.
      The influence of clinical assessment (including age) and geriatric assessment on treatment decisions in older patients with cancer.
      ]
      2013FVarious cancer typesAge ≥ 70 years50536%¥76 (70–96) ¥XX
      Magnuson [
      • Magnuson A.
      • Lemelman T.
      • Pandya C.
      • et al.
      Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study.
      ]
      2017FVarious cancer typesAge ≥ 70 years7156%76 (70–89)XX
      Mertens [
      • Mertens C.
      • le Caer H.
      • Ortholan C.
      • et al.
      The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use by oncologists to classify patients as fit or unfit.
      ]
      2017AHead and neck cancerAge ≥ 70 years46374%79 (70–95)XX
      Mohile [
      • Mohile S.G.
      • Mohamed M.R.
      • Xu H.
      • et al.
      Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
      ,
      • Mohile S.G.
      • Epstein R.M.
      • Hurria A.
      • et al.
      Communication with older patients with Cancer using geriatric assessment: A cluster-randomized clinical trial from the National Cancer Institute Community oncology research program.
      ]
      2021FVarious cancer typesAge ≥ 70 years, starting chemotherapy71857%77.2 (SD 5.4)XXX
      Weltermann [
      • Weltermann A.K.H.
      Diagnostic yield of a Geriatric assessment and a standardized intervention plan in elderly patients with newly diagnosed cancer: A cohort study.
      ]
      2011AVarious cancer typesAge ≥ 70 years5059%77 (70–91)X
      Studies using a multidisciplinary team of two or more (para)medical health care professionals for the geriatric assessment (M)
      Andreozzi [
      • Andreozzi J.
      • Dale W.
      • Fan L.
      • Mohile S.
      Feasibility of integrating comprehensive geriatric assessment-driven interventions into standard oncology practice in real time.
      ]
      2011AVarious cancer typesAll consecutive referrals51?82 (68–95)X
      Chapman [
      • Chapman A.E.
      • Swartz K.
      • Schoppe J.
      • Arenson C.
      Development of a comprehensive multidisciplinary geriatric oncology center, the Thomas Jefferson university experience.
      ]
      2014FVarious cancer typesAll consecutive referrals211?81 (61–95)X
      Derman [
      • Derman B.A.
      • Kordas K.
      • Ridgeway J.
      • et al.
      Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults.
      ]
      2019FHaematological malignanciesAge ≥ 60 years247?68 (43–83)XX
      Extermann [
      • Extermann M.
      • Meyer J.
      • McGinnis M.
      • et al.
      A comprehensive geriatric intervention detects multiple problems in older breast cancer patients.
      ]
      2004FEarly stage breast cancerAge ≥ 70 years150%79 (72–87)X
      Fletcher [
      • Fletcher J.
      • Sanmugarajah J.
      • Caird S.
      • Allen M.
      • Quennell A.
      • Powell M.
      Assessing treatment tolerability after geriatric assessment in the senior oncology clinic at the gold coast university hospital.
      ]
      2017AVarious cancer typesAge ≥ 70 years14954%83 (?)XX
      Ho [
      • Ho M.F.
      • Dai D.L.K.
      • Lee J.F.Y.
      • et al.
      A randomized controlled clinical trial to assess the impact of enhanced geriatric input on elderly patients undergoing colorectal cancer surgery.
      ]
      2017AColorectal cancerAge > 70 years, considered for surgery74??X
      Huillard [
      • Huillard O.
      • Boudou-Rouquette P.
      • Chahwakilian A.
      • et al.
      Multidisciplinary risk assessment to reveal cancer treatments in complex cancer patients.
      ]
      2014AVarious cancer typesComplex patients8776%81 (25–94)X
      Hurria [
      • Hurria A.
      • Lichtman S.M.
      • Gardes J.
      • et al.
      Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice.
      ]
      2007FVarious cancer typesAge ≥ 65 years24529%76 (65–95)X
      Li [
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ]
      2021FVarious cancer typesAge ≥ 65 years, starting chemotherapy60541%71 (65–91)XXX
      Mak [
      • Mak T.
      • Dal D.
      • Wa Leung W.
      • Lee J.
      • Ng S.
      A pilot study of enhanced geriatric input in management of elderly patients undergoing colorectal cancer surgery.
      ]
      2014AColorectal cancerAge > 70, years planned for surgery39??X
      Odetto [
      • Odetto D.
      • Smietniansky M.
      • Noll F.
      • Boietti B.
      • Perrotta M.
      Impact of a geriatric consultation in the decision making process for patients with gynecological cancer.
      ]
      2016AColorectal cancerAge ≥ 70 years, planned surgery38??X
      Pattinson [

      Pattinson J. SA, CA, MT, MR. Does comprehensive geriatric assessment affect decision-making & outcomes for older adults treated for upper gastro-intestinal cancer. Eur Geriatric Med 2016;7:S101.

      ]
      2016AUpper gastrointestinal tumoursAge ≥ 70 years9764%?XX
      Rao [
      • Rao A.
      • v., Hsieh F, Feussner JR, Cohen HJ.
      Geriatric assessment and management units in the care of the frail elderly cancer patient.
      ]
      2005FVarious cancer typesAge ≥ 65 years, hospitalized9998%74 (?)X
      Santos [
      • Santos G.H.
      • de la O Murillo A, de Celis ESP.
      Effect of a geriatric management unit on the outcomes of hospitalized older adults with cancer in Mexico.
      ]
      2021AVarious cancer typesAge ≥ 65 years, hospitalized300?75 (?)X
      Van der Vlies [
      • van der Vlies E.
      • Smits A.B.
      • Los M.
      • et al.
      Implementation of a preoperative multidisciplinary team approach for frail colorectal cancer patients: influence on patient selection, prehabilitation and outcome.
      ]
      2020FColorectal cancerAge ≥ 70 years, considered for surgery14651%80 (75–83)X
      Wang [
      • Wang M.
      • Ho F.
      • Ng Y.S.
      • Tai B.C.
      • Yong W.C.
      • Pang S.L.A.
      CGA directed interventions in Asian geriatric oncology patients.
      ]
      2018AVarious cancer typesAge ≥ 70 years136??X
      ? not reported.
      Toxicity or treatment-related complications, treatment completion, quality of life or physical functioning, mortality, and health care utilisation.
      ¥ Data only available for full study population, not specific to subgroup addressing review question.
      Overall, 29 studies addressed the comparison between the oncologic treatment plan before and after geriatric assessment, of which 21 described the change in treatment plan for individual patients [
      • SA Alexander K.
      • SS K.G.B.
      Geriatric assessment in older cancer patients and its potential impact on surgical treatment decisions.
      ,
      • Bossi P.
      • Esposito A.
      • Vecchio S.
      • et al.
      Role of geriatric assessment in tailoring treatment of locally advanced head and neck cancer: the ELDERLY study.
      ,
      • Festen S.
      • Kok M.
      • Hopstaken J.S.
      • et al.
      How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study.
      ,
      • Garric M.
      • Sourdet S.
      • Cabarrou B.
      • et al.
      Impact of a comprehensive geriatric assessment on decision-making in older patients with hematological malignancies.
      ,
      • Gunaydin U.M.
      • Cincin A.T.
      • Gunaydin S.
      • et al.
      Analysis of feasibility of geriatric assessment tools in elderly cancer patients and effects on anti-cancer treatment planning.
      ,
      • Lola C.
      • Emmanuelle B.
      • Elias A.
      • et al.
      Geriatric assessment in decision-making process in older patients with breast cancer: the ELCAPA cohort study.
      ,
      • Plana M.
      • Taberna M.
      • Llop S.
      • et al.
      Impact of geriatric assessment on the management of older head and neck cancer patients.
      ,
      • Almugbel F.
      Role of the vulnerable elders survey-13 screening tool in predicting treatment plan modification for older adults with cancer.
      ,
      • Aliamus V.
      • Adam C.
      • Druet-Cabanac M.
      • Dantoine T.
      • Vergnenegre A.
      Geriatric assessment contribution to treatment decision-making in thoracic oncology.
      ,
      • Blanco R.
      • Capo M.
      • Libran A.M.
      • et al.
      Multidisciplinary treatment planning in elderly patients with cancer: A prospective observational study.
      ,
      • Boulahssass R.
      • Gonfrier S.
      • Isabelle B.
      • et al.
      Influence of the comprehensive geriatric assessment (CGA) in elderly metastatic cancer patients. Analysis from a prospective cohort of 1048 patients.
      ,
      • Caillet P.
      • Canoui-Poitrine F.
      • Vouriot J.
      • et al.
      Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
      ,
      • Chaïbi P.
      • Magné N.
      • Breton S.
      • et al.
      Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.
      ,
      • Girre V.
      • Falcou M.C.
      • Gisselbrecht M.
      • et al.
      Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?.
      ,
      • Horgan A.M.
      • Leighl N.B.
      • Coate L.
      • et al.
      Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: A pilot study.
      ,
      • Huillard O.
      • Boudou-Rouquette P.
      • Chahwakilian A.
      • et al.
      Multidisciplinary risk assessment to reveal cancer treatments in complex cancer patients.
      ,
      • Mertens C.
      • le Caer H.
      • Ortholan C.
      • et al.
      The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use by oncologists to classify patients as fit or unfit.
      ,
      • Odetto D.
      • Smietniansky M.
      • Noll F.
      • Boietti B.
      • Perrotta M.
      Impact of a geriatric consultation in the decision making process for patients with gynecological cancer.
      ,
      • Bugat M.E.R.
      • Gerard S.
      • Balardy L.
      • et al.
      Impact of an oncogeriatric consulting team on therapeutic decision-making.
      ,
      • Decoster L.
      • Kenis C.
      • van Puyvelde K.
      • et al.
      The influence of clinical assessment (including age) and geriatric assessment on treatment decisions in older patients with cancer.
      ] and eight described differences in treatment choice between cohorts that did or did not undergo a geriatric assessment [
      • Derman B.A.
      • Kordas K.
      • Ridgeway J.
      • et al.
      Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults.
      ,
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ,
      • Mohile S.G.
      • Mohamed M.R.
      • Xu H.
      • et al.
      Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
      ,
      • Nadaraja S.
      • Matzen L.E.
      • Jørgensen T.L.
      • et al.
      The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial.
      ,
      • Fletcher J.
      • Sanmugarajah J.
      • Caird S.
      • Allen M.
      • Quennell A.
      • Powell M.
      Assessing treatment tolerability after geriatric assessment in the senior oncology clinic at the gold coast university hospital.
      ,
      • Kalsi T.
      • Babic-Illman G.
      • Ross P.J.
      • et al.
      The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
      ,
      • Magnuson A.
      • Lemelman T.
      • Pandya C.
      • et al.
      Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study.
      ,

      Pattinson J. SA, CA, MT, MR. Does comprehensive geriatric assessment affect decision-making & outcomes for older adults treated for upper gastro-intestinal cancer. Eur Geriatric Med 2016;7:S101.

      ]. Three studies discussed the effect on communication and care planning [
      • DuMontier C.
      • Uno H.
      • Hshieh T.
      • et al.
      Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies.
      ,
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ,
      • Mohile S.G.
      • Mohamed M.R.
      • Xu H.
      • et al.
      Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
      ]. Thirty-three studies reported on the number and type of recommended non-oncologic interventions [
      • Bossi P.
      • Esposito A.
      • Vecchio S.
      • et al.
      Role of geriatric assessment in tailoring treatment of locally advanced head and neck cancer: the ELDERLY study.
      ,
      • Dougoud Chauvin V.
      • Szüts N.
      • Laszlo A.
      • Betticher D.C.
      A new oncogeriatric consultation: patient characteristics and the support installed demonstrating its need!.
      ,
      • Festen S.
      • Kok M.
      • Hopstaken J.S.
      • et al.
      How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study.
      ,
      • Giger A.K.W.
      • Nadaraja S.
      • Jeppesen S.S.
      • Thomsen K.
      • Matzen L.E.
      Most patients with cancer referred to comprehensive geriatric assessment are in need of geriatric intervention.
      ,
      • Handforth C.
      • Burkinshaw R.
      • Freeman J.
      • et al.
      Comprehensive geriatric assessment and decision-making in older men with incurable but manageable (chronic) cancer.
      ,
      • Jolly T.A.
      • Deal A.M.
      • Mariano C.
      • et al.
      A randomized trial of real-time geriatric assessment reporting in nonelectively hospitalized older adults with Cancer.
      ,
      • Kenis C.
      • Decoster L.
      • Flamaing J.
      • et al.
      Adherence to geriatric assessment-based recommendations in older patients with cancer: A multicenter prospective cohort study in Belgium.
      ,
      • Lund C.M.
      • Vistisen K.K.
      • Olsen A.P.
      • et al.
      The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO).
      ,
      • Molga A.
      • Wall M.
      • Chhetri R.
      • et al.
      Geriatric assessment in older people with myelodysplasia is predictive of azacitidine therapy completion and survival: A prospective interventional study at the royal Adelaide hospital.
      ,
      • Ørum M.
      • Eriksen S.V.
      • Gregersen M.
      • et al.
      The impact of a tailored follow-up intervention on comprehensive geriatric assessment in older patients with cancer - a randomised controlled trial.
      ,
      • Ørum M.
      • Jensen K.
      • Gregersen M.
      • Meldgaard P.
      • Damsgaard E.M.
      Impact of comprehensive geriatric assessment on short-term mortality in older patients with cancer—a follow-up study.
      ,
      • Plana M.
      • Taberna M.
      • Llop S.
      • et al.
      Impact of geriatric assessment on the management of older head and neck cancer patients.
      ,
      • van der Vlies E.
      • Smits A.B.
      • Los M.
      • et al.
      Implementation of a preoperative multidisciplinary team approach for frail colorectal cancer patients: influence on patient selection, prehabilitation and outcome.
      ,
      • Wang M.
      • Ho F.
      • Ng Y.S.
      • Tai B.C.
      • Yong W.C.
      • Pang S.L.A.
      CGA directed interventions in Asian geriatric oncology patients.
      ,
      • Andreozzi J.
      • Dale W.
      • Fan L.
      • Mohile S.
      Feasibility of integrating comprehensive geriatric assessment-driven interventions into standard oncology practice in real time.
      ,
      • Aparicio T.
      • Girard L.
      • Bouarioua N.
      • Patry C.
      • Legrain S.
      • Soulé J.C.
      A mini geriatric assessment helps treatment decision in elderly patients with digestive cancer. A pilot study.
      ,
      • Bastos-Oreiro M.
      • Rodriguez-Macias G.
      • Pradillo V.
      • et al.
      A prospective study to evaluate the utility of geriatric assessment and intervetnion in patients with lymphoproliferative disorders in a tertiary hospital.
      ,
      • Caillet P.
      • Canoui-Poitrine F.
      • Vouriot J.
      • et al.
      Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
      ,
      • Chaïbi P.
      • Magné N.
      • Breton S.
      • et al.
      Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.
      ,
      • Chapman A.E.
      • Swartz K.
      • Schoppe J.
      • Arenson C.
      Development of a comprehensive multidisciplinary geriatric oncology center, the Thomas Jefferson university experience.
      ,
      • Extermann M.
      • Meyer J.
      • McGinnis M.
      • et al.
      A comprehensive geriatric intervention detects multiple problems in older breast cancer patients.
      ,

      Frennet M Kjcphylv de SHM Impact of comprehensive geriatric assessment (CGA) during oncologic treatment in frail elderly patients. Eur Geriatric Med 2011;(2):S35.

      ,
      • Horgan A.M.
      • Leighl N.B.
      • Coate L.
      • et al.
      Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: A pilot study.
      ,
      • Hurria A.
      • Lichtman S.M.
      • Gardes J.
      • et al.
      Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice.
      ,
      • Kalsi T.
      • Babic-Illman G.
      • Ross P.J.
      • et al.
      The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
      ,
      • Kenis C.
      • Bron D.
      • Libert Y.
      • et al.
      Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study.
      ,
      • Magnuson A.
      • Lemelman T.
      • Pandya C.
      • et al.
      Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study.
      ,
      • Mertens C.
      • le Caer H.
      • Ortholan C.
      • et al.
      The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use by oncologists to classify patients as fit or unfit.
      ,
      • Ommundsen N.
      • Wyller T.B.
      • Nesbakken A.
      • et al.
      Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial.
      ,
      • Palicio C.
      • Boqué C.
      • Antonio M.
      • Bidó M.
      Comprehensive geriatric assessment and intervention proposal in an outpatient hematology ward.
      ,
      • Schiphorst A.H.W.
      • ten Bokkel Huinink D.
      • Breumelhof R.
      • Burgmans J.P.J.
      • Pronk A.
      • Hamaker M.E.
      Geriatric consultation can aid in complex treatment decisions for elderly cancer patients.
      ,
      • Schulkes K.J.G.
      • Souwer E.T.D.
      • Hamaker M.E.
      • et al.
      The effect of A geriatric assessment on treatment decisions for patients with lung Cancer.
      ,
      • Weltermann A.K.H.
      Diagnostic yield of a Geriatric assessment and a standardized intervention plan in elderly patients with newly diagnosed cancer: A cohort study.
      ], and 21 studies addressed the effect on treatment outcome, of which 14 were randomised controlled trials [
      • DuMontier C.
      • Uno H.
      • Hshieh T.
      • et al.
      Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies.
      ,
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ,
      • Lund C.M.
      • Vistisen K.K.
      • Olsen A.P.
      • et al.
      The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO).
      ,
      • Mohile S.G.
      • Mohamed M.R.
      • Xu H.
      • et al.
      Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
      ,
      • Nadaraja S.
      • Matzen L.E.
      • Jørgensen T.L.
      • et al.
      The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial.
      ,
      • Soo W.-K.
      • King M.
      • Pope A.
      • Parente P.
      • Darzins P.
      • Davis I.D.
      • et al.
      Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy.
      ,
      • Corre R.
      • Greillier L.
      • le Caër H.
      • et al.
      Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small cell lung cancer: the Phase III randomized ESOGIA-GFPC-GECP 08-02 Study.
      ,
      • Hempenius L.
      • Slaets J.P.J.
      • van Asselt D.
      • de Bock G.H.
      • Wiggers T.
      • van Leeuwen B.L.
      Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly Cancer patients: report on a multicentre, randomized, controlled trial.
      ,
      • Ho M.F.
      • Dai D.L.K.
      • Lee J.F.Y.
      • et al.
      A randomized controlled clinical trial to assess the impact of enhanced geriatric input on elderly patients undergoing colorectal cancer surgery.
      ,
      • Magnuson A.
      • Lemelman T.
      • Pandya C.
      • et al.
      Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study.
      ,
      • Odetto D.
      • Smietniansky M.
      • Noll F.
      • Boietti B.
      • Perrotta M.
      Impact of a geriatric consultation in the decision making process for patients with gynecological cancer.
      ,
      • Ommundsen N.
      • Wyller T.B.
      • Nesbakken A.
      • et al.
      Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial.
      ,
      • Puts M.T.E.
      • Sattar S.
      • Kulik M.
      • et al.
      A randomized phase II trial of geriatric assessment and management for older cancer patients.
      ,
      • Rao A.
      • v., Hsieh F, Feussner JR, Cohen HJ.
      Geriatric assessment and management units in the care of the frail elderly cancer patient.
      ].

      3.2 Quality assessment

      The results of the quality assessment can be found in Fig. 2; detailed results per study are listed in Appendix 1b. The overall quality of the studies appeared good, but the risk of bias was unclear or high for about 50% of studies for the outcome ‘adequacy of follow-up’. This is partially due to the fact that for 25 studies, only a conference abstract was available, providing only limited data on the methodology. Seven studies assessing the effect on treatment outcome used matched or historic comparisons [
      • Derman B.A.
      • Kordas K.
      • Ridgeway J.
      • et al.
      Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults.
      ,
      • Santos G.H.
      • de la O Murillo A, de Celis ESP.
      Effect of a geriatric management unit on the outcomes of hospitalized older adults with cancer in Mexico.
      ,
      • Fletcher J.
      • Sanmugarajah J.
      • Caird S.
      • Allen M.
      • Quennell A.
      • Powell M.
      Assessing treatment tolerability after geriatric assessment in the senior oncology clinic at the gold coast university hospital.
      ,
      • Kalsi T.
      • Babic-Illman G.
      • Ross P.J.
      • et al.
      The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
      ,
      • Mak T.
      • Dal D.
      • Wa Leung W.
      • Lee J.
      • Ng S.
      A pilot study of enhanced geriatric input in management of elderly patients undergoing colorectal cancer surgery.
      ,

      Pattinson J. SA, CA, MT, MR. Does comprehensive geriatric assessment affect decision-making & outcomes for older adults treated for upper gastro-intestinal cancer. Eur Geriatric Med 2016;7:S101.

      ,
      • Singh S.H.R.
      • SD, MK.
      Perioperative comprehensive geriatric assessment is associated with reduced inpatient length of stay.
      ], rather than randomisation, which may have created bias or confounding. Three studies had follow-up rate of less than 90% [
      • Hempenius L.
      • Slaets J.P.J.
      • van Asselt D.
      • de Bock G.H.
      • Wiggers T.
      • van Leeuwen B.L.
      Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly Cancer patients: report on a multicentre, randomized, controlled trial.
      ,
      • Kenis C.
      • Bron D.
      • Libert Y.
      • et al.
      Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study.
      ,
      • Puts M.T.E.
      • Sattar S.
      • Kulik M.
      • et al.
      A randomized phase II trial of geriatric assessment and management for older cancer patients.
      ]. No other risks of bias were identified.
      Fig. 2
      Fig. 2Outcome of the quality assessment. Details are reported in Appendix 1a (quality assessment questionnaire) and 1b (assessment per study).

      3.3 Effect on oncologic treatment decisions

      Twenty-one studies described changes in the oncologic treatment for individual patients as a result of the geriatric assessment [
      • SA Alexander K.
      • SS K.G.B.
      Geriatric assessment in older cancer patients and its potential impact on surgical treatment decisions.
      ,
      • Bossi P.
      • Esposito A.
      • Vecchio S.
      • et al.
      Role of geriatric assessment in tailoring treatment of locally advanced head and neck cancer: the ELDERLY study.
      ,
      • Festen S.
      • Kok M.
      • Hopstaken J.S.
      • et al.
      How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study.
      ,
      • Garric M.
      • Sourdet S.
      • Cabarrou B.
      • et al.
      Impact of a comprehensive geriatric assessment on decision-making in older patients with hematological malignancies.
      ,
      • Gunaydin U.M.
      • Cincin A.T.
      • Gunaydin S.
      • et al.
      Analysis of feasibility of geriatric assessment tools in elderly cancer patients and effects on anti-cancer treatment planning.
      ,
      • Lola C.
      • Emmanuelle B.
      • Elias A.
      • et al.
      Geriatric assessment in decision-making process in older patients with breast cancer: the ELCAPA cohort study.
      ,
      • Plana M.
      • Taberna M.
      • Llop S.
      • et al.
      Impact of geriatric assessment on the management of older head and neck cancer patients.
      ,
      • Almugbel F.
      Role of the vulnerable elders survey-13 screening tool in predicting treatment plan modification for older adults with cancer.
      ,
      • Aliamus V.
      • Adam C.
      • Druet-Cabanac M.
      • Dantoine T.
      • Vergnenegre A.
      Geriatric assessment contribution to treatment decision-making in thoracic oncology.
      ,
      • Blanco R.
      • Capo M.
      • Libran A.M.
      • et al.
      Multidisciplinary treatment planning in elderly patients with cancer: A prospective observational study.
      ,
      • Boulahssass R.
      • Gonfrier S.
      • Isabelle B.
      • et al.
      Influence of the comprehensive geriatric assessment (CGA) in elderly metastatic cancer patients. Analysis from a prospective cohort of 1048 patients.
      ,
      • Caillet P.
      • Canoui-Poitrine F.
      • Vouriot J.
      • et al.
      Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
      ,
      • Chaïbi P.
      • Magné N.
      • Breton S.
      • et al.
      Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.
      ,
      • Girre V.
      • Falcou M.C.
      • Gisselbrecht M.
      • et al.
      Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?.
      ,
      • Horgan A.M.
      • Leighl N.B.
      • Coate L.
      • et al.
      Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: A pilot study.
      ,
      • Huillard O.
      • Boudou-Rouquette P.
      • Chahwakilian A.
      • et al.
      Multidisciplinary risk assessment to reveal cancer treatments in complex cancer patients.
      ,
      • Mertens C.
      • le Caer H.
      • Ortholan C.
      • et al.
      The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use by oncologists to classify patients as fit or unfit.
      ,
      • Odetto D.
      • Smietniansky M.
      • Noll F.
      • Boietti B.
      • Perrotta M.
      Impact of a geriatric consultation in the decision making process for patients with gynecological cancer.
      ,
      • Bugat M.E.R.
      • Gerard S.
      • Balardy L.
      • et al.
      Impact of an oncogeriatric consulting team on therapeutic decision-making.
      ,
      • Decoster L.
      • Kenis C.
      • van Puyvelde K.
      • et al.
      The influence of clinical assessment (including age) and geriatric assessment on treatment decisions in older patients with cancer.
      ]. The median proportion of patients in which the treatment plan changed was 31% (range 6–56%), primarily in favour of a less intensive treatment option (median 73% of changes, Appendix 2a).
      For the eleven studies using a geriatric consultation [
      • SA Alexander K.
      • SS K.G.B.
      Geriatric assessment in older cancer patients and its potential impact on surgical treatment decisions.
      ,
      • Bossi P.
      • Esposito A.
      • Vecchio S.
      • et al.
      Role of geriatric assessment in tailoring treatment of locally advanced head and neck cancer: the ELDERLY study.
      ,
      • Garric M.
      • Sourdet S.
      • Cabarrou B.
      • et al.
      Impact of a comprehensive geriatric assessment on decision-making in older patients with hematological malignancies.
      ,
      • Lola C.
      • Emmanuelle B.
      • Elias A.
      • et al.
      Geriatric assessment in decision-making process in older patients with breast cancer: the ELCAPA cohort study.
      ,
      • Plana M.
      • Taberna M.
      • Llop S.
      • et al.
      Impact of geriatric assessment on the management of older head and neck cancer patients.
      ,
      • Almugbel F.
      Role of the vulnerable elders survey-13 screening tool in predicting treatment plan modification for older adults with cancer.
      ,
      • Caillet P.
      • Canoui-Poitrine F.
      • Vouriot J.
      • et al.
      Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
      ,
      • Chaïbi P.
      • Magné N.
      • Breton S.
      • et al.
      Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.
      ,
      • Horgan A.M.
      • Leighl N.B.
      • Coate L.
      • et al.
      Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: A pilot study.
      ,
      • Bugat M.E.R.
      • Gerard S.
      • Balardy L.
      • et al.
      Impact of an oncogeriatric consulting team on therapeutic decision-making.
      ,
      • Schulkes K.J.G.
      • Souwer E.T.D.
      • Hamaker M.E.
      • et al.
      The effect of A geriatric assessment on treatment decisions for patients with lung Cancer.
      ], the median percentage of patients with treatment adjustments was 22% (range 7–49%); for studies using an assessment by the oncology team (n = 8) [
      • Festen S.
      • Kok M.
      • Hopstaken J.S.
      • et al.
      How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study.
      ,
      • Gunaydin U.M.
      • Cincin A.T.
      • Gunaydin S.
      • et al.
      Analysis of feasibility of geriatric assessment tools in elderly cancer patients and effects on anti-cancer treatment planning.
      ,
      • Aliamus V.
      • Adam C.
      • Druet-Cabanac M.
      • Dantoine T.
      • Vergnenegre A.
      Geriatric assessment contribution to treatment decision-making in thoracic oncology.
      ,
      • Blanco R.
      • Capo M.
      • Libran A.M.
      • et al.
      Multidisciplinary treatment planning in elderly patients with cancer: A prospective observational study.
      ,
      • Boulahssass R.
      • Gonfrier S.
      • Isabelle B.
      • et al.
      Influence of the comprehensive geriatric assessment (CGA) in elderly metastatic cancer patients. Analysis from a prospective cohort of 1048 patients.
      ,
      • Girre V.
      • Falcou M.C.
      • Gisselbrecht M.
      • et al.
      Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?.
      ,
      • Mertens C.
      • le Caer H.
      • Ortholan C.
      • et al.
      The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use by oncologists to classify patients as fit or unfit.
      ,
      • Decoster L.
      • Kenis C.
      • van Puyvelde K.
      • et al.
      The influence of clinical assessment (including age) and geriatric assessment on treatment decisions in older patients with cancer.
      ], it was 28% (6–45%). In the two studies using a multidisciplinary team evaluation [
      • Huillard O.
      • Boudou-Rouquette P.
      • Chahwakilian A.
      • et al.
      Multidisciplinary risk assessment to reveal cancer treatments in complex cancer patients.
      ,
      • Odetto D.
      • Smietniansky M.
      • Noll F.
      • Boietti B.
      • Perrotta M.
      Impact of a geriatric consultation in the decision making process for patients with gynecological cancer.
      ], 54% and 56% of treatment choices were altered by the geriatric assessment (p-value for pooled data <0.001, Appendix 2b).
      A further eight studies described differences in treatment choice between two cohorts that did or did not undergo a geriatric assessment [
      • Derman B.A.
      • Kordas K.
      • Ridgeway J.
      • et al.
      Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults.
      ,
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ,
      • Mohile S.G.
      • Mohamed M.R.
      • Xu H.
      • et al.
      Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
      ,
      • Nadaraja S.
      • Matzen L.E.
      • Jørgensen T.L.
      • et al.
      The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial.
      ,
      • Fletcher J.
      • Sanmugarajah J.
      • Caird S.
      • Allen M.
      • Quennell A.
      • Powell M.
      Assessing treatment tolerability after geriatric assessment in the senior oncology clinic at the gold coast university hospital.
      ,
      • Kalsi T.
      • Babic-Illman G.
      • Ross P.J.
      • et al.
      The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
      ,
      • Magnuson A.
      • Lemelman T.
      • Pandya C.
      • et al.
      Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study.
      ,

      Pattinson J. SA, CA, MT, MR. Does comprehensive geriatric assessment affect decision-making & outcomes for older adults treated for upper gastro-intestinal cancer. Eur Geriatric Med 2016;7:S101.

      ]. One study assigned treatment purely based on a geriatric assessment-based algorithm [
      • Corre R.
      • Greillier L.
      • le Caër H.
      • et al.
      Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small cell lung cancer: the Phase III randomized ESOGIA-GFPC-GECP 08-02 Study.
      ]. Lung cancer patients in this intervention arm received significantly more combination chemotherapy (45% vs. 35% of patients randomised to usual care), less mono-chemotherapy (31% vs. 65% respectively) and more best supportive care (23% vs. 0%, respectively; overall p-value<0.001). In three other randomised trials comparing patients with and without a geriatric assessment, two found no significant differences between study arms [
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ,
      • Nadaraja S.
      • Matzen L.E.
      • Jørgensen T.L.
      • et al.
      The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial.
      ] and one reported significantly more upfront dose reductions in the geriatric assessment arm (49% vs. 35% of usual care patients, p = 0.02) [
      • Mohile S.G.
      • Mohamed M.R.
      • Xu H.
      • et al.
      Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
      ]. This trial used an intervention protocol tailored to the outcome of the geriatric assessment, in which reducing dosage was one of the predefined intervention options.
      Four studies using historic or matched controls found varying results, with one reporting no difference between geriatric assessment and control patients [
      • Derman B.A.
      • Kordas K.
      • Ridgeway J.
      • et al.
      Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults.
      ], two reporting more intensive treatment in the geriatric assessment cohort [
      • Fletcher J.
      • Sanmugarajah J.
      • Caird S.
      • Allen M.
      • Quennell A.
      • Powell M.
      Assessing treatment tolerability after geriatric assessment in the senior oncology clinic at the gold coast university hospital.
      ,

      Pattinson J. SA, CA, MT, MR. Does comprehensive geriatric assessment affect decision-making & outcomes for older adults treated for upper gastro-intestinal cancer. Eur Geriatric Med 2016;7:S101.

      ], and a fourth reporting more up-front dose reduction after geriatric assessment [
      • Kalsi T.
      • Babic-Illman G.
      • Ross P.J.
      • et al.
      The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
      ].

      3.4 Effect on non-oncologic treatment

      Thirty-three studies reported on the number and type of recommended non-oncologic interventions after geriatric assessment [
      • Bossi P.
      • Esposito A.
      • Vecchio S.
      • et al.
      Role of geriatric assessment in tailoring treatment of locally advanced head and neck cancer: the ELDERLY study.
      ,
      • Dougoud Chauvin V.
      • Szüts N.
      • Laszlo A.
      • Betticher D.C.
      A new oncogeriatric consultation: patient characteristics and the support installed demonstrating its need!.
      ,
      • Festen S.
      • Kok M.
      • Hopstaken J.S.
      • et al.
      How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study.
      ,
      • Giger A.K.W.
      • Nadaraja S.
      • Jeppesen S.S.
      • Thomsen K.
      • Matzen L.E.
      Most patients with cancer referred to comprehensive geriatric assessment are in need of geriatric intervention.
      ,
      • Handforth C.
      • Burkinshaw R.
      • Freeman J.
      • et al.
      Comprehensive geriatric assessment and decision-making in older men with incurable but manageable (chronic) cancer.
      ,
      • Jolly T.A.
      • Deal A.M.
      • Mariano C.
      • et al.
      A randomized trial of real-time geriatric assessment reporting in nonelectively hospitalized older adults with Cancer.
      ,
      • Kenis C.
      • Decoster L.
      • Flamaing J.
      • et al.
      Adherence to geriatric assessment-based recommendations in older patients with cancer: A multicenter prospective cohort study in Belgium.
      ,
      • Lund C.M.
      • Vistisen K.K.
      • Olsen A.P.
      • et al.
      The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO).
      ,
      • Molga A.
      • Wall M.
      • Chhetri R.
      • et al.
      Geriatric assessment in older people with myelodysplasia is predictive of azacitidine therapy completion and survival: A prospective interventional study at the royal Adelaide hospital.
      ,
      • Ørum M.
      • Eriksen S.V.
      • Gregersen M.
      • et al.
      The impact of a tailored follow-up intervention on comprehensive geriatric assessment in older patients with cancer - a randomised controlled trial.
      ,
      • Ørum M.
      • Jensen K.
      • Gregersen M.
      • Meldgaard P.
      • Damsgaard E.M.
      Impact of comprehensive geriatric assessment on short-term mortality in older patients with cancer—a follow-up study.
      ,
      • Plana M.
      • Taberna M.
      • Llop S.
      • et al.
      Impact of geriatric assessment on the management of older head and neck cancer patients.
      ,
      • van der Vlies E.
      • Smits A.B.
      • Los M.
      • et al.
      Implementation of a preoperative multidisciplinary team approach for frail colorectal cancer patients: influence on patient selection, prehabilitation and outcome.
      ,
      • Wang M.
      • Ho F.
      • Ng Y.S.
      • Tai B.C.
      • Yong W.C.
      • Pang S.L.A.
      CGA directed interventions in Asian geriatric oncology patients.
      ,
      • Andreozzi J.
      • Dale W.
      • Fan L.
      • Mohile S.
      Feasibility of integrating comprehensive geriatric assessment-driven interventions into standard oncology practice in real time.
      ,
      • Aparicio T.
      • Girard L.
      • Bouarioua N.
      • Patry C.
      • Legrain S.
      • Soulé J.C.
      A mini geriatric assessment helps treatment decision in elderly patients with digestive cancer. A pilot study.
      ,
      • Bastos-Oreiro M.
      • Rodriguez-Macias G.
      • Pradillo V.
      • et al.
      A prospective study to evaluate the utility of geriatric assessment and intervetnion in patients with lymphoproliferative disorders in a tertiary hospital.
      ,
      • Caillet P.
      • Canoui-Poitrine F.
      • Vouriot J.
      • et al.
      Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
      ,
      • Chaïbi P.
      • Magné N.
      • Breton S.
      • et al.
      Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.
      ,
      • Chapman A.E.
      • Swartz K.
      • Schoppe J.
      • Arenson C.
      Development of a comprehensive multidisciplinary geriatric oncology center, the Thomas Jefferson university experience.
      ,
      • Extermann M.
      • Meyer J.
      • McGinnis M.
      • et al.
      A comprehensive geriatric intervention detects multiple problems in older breast cancer patients.
      ,

      Frennet M Kjcphylv de SHM Impact of comprehensive geriatric assessment (CGA) during oncologic treatment in frail elderly patients. Eur Geriatric Med 2011;(2):S35.

      ,
      • Horgan A.M.
      • Leighl N.B.
      • Coate L.
      • et al.
      Impact and feasibility of a comprehensive geriatric assessment in the oncology setting: A pilot study.
      ,
      • Hurria A.
      • Lichtman S.M.
      • Gardes J.
      • et al.
      Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice.
      ,
      • Kalsi T.
      • Babic-Illman G.
      • Ross P.J.
      • et al.
      The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
      ,
      • Kenis C.
      • Bron D.
      • Libert Y.
      • et al.
      Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study.
      ,
      • Magnuson A.
      • Lemelman T.
      • Pandya C.
      • et al.
      Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study.
      ,
      • Mertens C.
      • le Caer H.
      • Ortholan C.
      • et al.
      The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use by oncologists to classify patients as fit or unfit.
      ,
      • Ommundsen N.
      • Wyller T.B.
      • Nesbakken A.
      • et al.
      Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial.
      ,
      • Palicio C.
      • Boqué C.
      • Antonio M.
      • Bidó M.
      Comprehensive geriatric assessment and intervention proposal in an outpatient hematology ward.
      ,
      • Schiphorst A.H.W.
      • ten Bokkel Huinink D.
      • Breumelhof R.
      • Burgmans J.P.J.
      • Pronk A.
      • Hamaker M.E.
      Geriatric consultation can aid in complex treatment decisions for elderly cancer patients.
      ,
      • Schulkes K.J.G.
      • Souwer E.T.D.
      • Hamaker M.E.
      • et al.
      The effect of A geriatric assessment on treatment decisions for patients with lung Cancer.
      ,
      • Weltermann A.K.H.
      Diagnostic yield of a Geriatric assessment and a standardized intervention plan in elderly patients with newly diagnosed cancer: A cohort study.
      ]. One or more non-oncologic interventions were proposed in the majority of patients (median 72%, range 6–100%). Polypharmacy and comorbidity optimization (median 38% and 30% of patients, respectively), nutritional support (median 37%) and social interventions (median 34%) were most commonly recommended. Details per study can be found in Appendix 3a.
      Fig. 3 shows the proportion of patients with (recommendations for) non-oncologic interventions according to type of assessment and the use of a pre-defined intervention protocol. For a multidisciplinary team evaluation, geriatric consultation with or without a pre-defined intervention protocol, and for an assessment by the oncology team with an intervention protocol, one or more interventions were recommended for over 70% of patients. However, for studies using an assessment by the oncology team without a pre-defined intervention protocol, non-oncologic interventions were only recommended for a median of 26% of patients. Although the difference is slightly smaller in the pooled data, it is still highly significant (p-value <0.001, Appendix 3b). The biggest discrepancy was seen for polypharmacy optimisation, social interventions, cognitive assessment or delirium prevention measures, and interventions aimed at physical function or mobility. All of these interventions were at least five times less likely to occur in the setting of an assessment by the oncology team without a predefined intervention protocol, compared to all other settings.
      Fig. 3
      Fig. 3Median proportion of patients with (recommendations for) non-oncologic interventions after geriatric assessment, according to type of assessment and use of an intervention protocol. Details per study and median calculations can be found in Appendix 3a. No studies assessed the effect of a multidisciplinary team with an intervention protocol. Chi-square p-value for differences between the groups in pooled data (Appendix 3b) was <0.001.

      3.5 Effect on communication and care planning

      Three randomised controlled trials reported on the effect of the geriatric assessment on communication and care planning [
      • DuMontier C.
      • Uno H.
      • Hshieh T.
      • et al.
      Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies.
      ,
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ,
      • Mohile S.G.
      • Epstein R.M.
      • Hurria A.
      • et al.
      Communication with older patients with Cancer using geriatric assessment: A cluster-randomized clinical trial from the National Cancer Institute Community oncology research program.
      ]. The results were consistent across trials for these outcomes. Li et al. found that in the geriatric assessment arm 28.4% of patients completed an advance directive compared to 13.3% in usual care (<0.001) [
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ]. The trial by Dumontier et al. found that a geriatric consultation increased the chance of patients discussing end-of-life goals of care with their doctors (odds ratio 3.12 compared to usual care) [
      • DuMontier C.
      • Uno H.
      • Hshieh T.
      • et al.
      Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies.
      ]. Finally, in the GAP70+ trial by Mohile et al., there were four times more ageing-related conversations in the intervention group's visits compared to the usual care arm [
      • Mohile S.G.
      • Epstein R.M.
      • Hurria A.
      • et al.
      Communication with older patients with Cancer using geriatric assessment: A cluster-randomized clinical trial from the National Cancer Institute Community oncology research program.
      ]. After the initial visit and at six months, patients in the intervention arm were significantly more satisfied with communication, as were these patients' caregivers [
      • Mohile S.G.
      • Epstein R.M.
      • Hurria A.
      • et al.
      Communication with older patients with Cancer using geriatric assessment: A cluster-randomized clinical trial from the National Cancer Institute Community oncology research program.
      ].

      3.6 Effect on treatment outcome

      Table 2 shows the results of the 21 studies reporting on the effect of geriatric assessment on treatment outcome, including 14 randomised controlled trials [
      • DuMontier C.
      • Uno H.
      • Hshieh T.
      • et al.
      Randomized controlled trial of geriatric consultation versus standard care in older adults with hematologic malignancies.
      ,
      • Li D.
      • Sun C.L.
      • Kim H.
      • et al.
      Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with Cancer: A randomized clinical trial.
      ,
      • Lund C.M.
      • Vistisen K.K.
      • Olsen A.P.
      • et al.
      The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO).
      ,
      • Mohile S.G.
      • Mohamed M.R.
      • Xu H.
      • et al.
      Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
      ,
      • Nadaraja S.
      • Matzen L.E.
      • Jørgensen T.L.
      • et al.
      The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial.
      ,
      • Soo W.-K.
      • King M.
      • Pope A.
      • Parente P.
      • Darzins P.
      • Davis I.D.
      • et al.
      Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy.
      ,
      • Corre R.
      • Greillier L.
      • le Caër H.
      • et al.
      Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small cell lung cancer: the Phase III randomized ESOGIA-GFPC-GECP 08-02 Study.
      ,
      • Hempenius L.
      • Slaets J.P.J.
      • van Asselt D.
      • de Bock G.H.
      • Wiggers T.
      • van Leeuwen B.L.
      Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly Cancer patients: report on a multicentre, randomized, controlled trial.