Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology
Open accessAbstract
Purpose: To provide guidance regarding the practical assessment and management of vulnerabilities in older patients undergoing chemotherapy. Methods: An Expert Panel was convened to develop clinical practice guideline recommendations based on a systematic review of the medical literature. Results: A total of 68 studies met eligibility criteria and form the evidentiary basis for the recommendations. Recommendations: In patients ≥ 65 years receiving chemotherapy, geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments. Evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition. The Panel recommends instrumental activities of daily living to assess for function, a thorough history or validated tool to assess comorbidity, a single question for falls, the Geriatric Depression Scale to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test to screen for cognitive impairment, and an assessment of unintentional weight loss to evaluate nutrition. Either the CARG (Cancer and Aging Research Group) or CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) tools are recommended to obtain estimates of chemotherapy toxicity risk; the Geriatric-8 or Vulnerable Elders Survey-13 can help to predict mortality. Clinicians should use a validated tool listed at ePrognosis to estimate noncancer-based life expectancy ≥ 4 years. GA results should be applied to develop an integrated and individualized plan that informs cancer management and to identify nononcologic problems amenable to intervention. Collaborating with caregivers is essential to implementing GA-guided interventions. The Panel suggests that clinicians take into account GA results when recommending chemotherapy and that the information be provided to patients and caregivers to guide treatment decision making. Clinicians should implement targeted, GA-guided interventions to manage nononcologic problems. Additional information is available at www.asco.org/supportive-care-guidelines .
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Flannery, M. A., Mohile, S. G., Dale, W., et al. (2016) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2016.02.001 · Cited by 16 · see citing works
Self-citationShared Goal Setting in Team-Based Geriatric Oncology
Magnuson, A. M., Wallace, J. A., Canin, B. E., Chow, S. L.-M., Dale, W., Mohile, S. G., & Hamel, L. M. (2016) · Journal of Oncology Practice · doi:10.1200/jop.2016.013623 · Cited by 16 · see citing works
Self-citationEffect of Burden of Comorbidity on Optimal Breast Cancer Treatment in Older Adults
Boureau, A., Bourbouloux, E., Rétornaz, F., et al. (2012) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12013 · Cited by 4 · see citing works
Baitar, A., Kenis, C., Moor, R., et al. (2016) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2016.01.005 · Cited by 3 · see citing works
Flagged first, then by citations
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Sorted by citations
Cancer statistics for adults aged 85 years and older, 2019
DeSantis, C. E., Miller, K. D., Dale, W., Mohile, S. G., Cohen, H. J., Leach, C. R., Goding Sauer, A., Jemal, A., & Siegel, R. L. (2019) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21577 · Cited by 370 · see citing works
Self-citationKadambi, S., Loh, K. P., Dunne, R., Magnuson, A., Maggiore, R., Zittel, J., Flannery, M., Inglis, J., Gilmore, N., Mohamed, M., et al. (2020) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-020-0421-z · Cited by 149 · see citing works
Self-citationQuality of Life of Caregivers of Older Patients with Advanced Cancer
Kehoe, L. A., Xu, H., Duberstein, P., Loh, K. P., Culakova, E., Canin, B., Hurria, A., Dale, W., Wells, M., Gilmore, N., et al. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15862 · Cited by 94 · see citing works
Self-citationBattisti, N. M. L., Mislang, A. R., Cooper, L., O'Donovan, A., Audisio, R. A., Cheung, K.-L., Sarrió, R. G., Stauder, R., Soto-Perez-de-Celis, E., Jaklitsch, M., et al. (2020) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2020.07.008 · Cited by 79 · see citing works
Self-citationTrujillo, E. B., Kadakia, K. C., Thomson, C., Zhang, F. F., Livinski, A., Pollard, K., Mattox, T., Tucker, A., Williams, V., Walsh, D., et al. (2024) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.2688 · Cited by 67 · see citing works
Mohile, S., Dumontier, C., Mian, H., Loh, K. P., Williams, G. R., Wildes, T. M., Boyd, K., Ramsdale, E., Pyne, S., Magnuson, A., et al. (2020) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2020.04.010 · Cited by 40 · see citing works
Self-citationXu, H., Kadambi, S., Mohile, S. G., Yang, S., Kehoe, L. A., Wells, M., Culakova, E., Kamen, C., Obrecht, S., Mohamed, M., et al. (2021) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2021.04.002 · Cited by 33 · see citing works
Self-citationMultidisciplinary care in the hematology clinic: implementation of geriatric oncology
Goede, V., & Stauder, R. (2019) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2018.09.003 · Cited by 28 · see citing works
- Authors
- Mohile, S. G., Dale, W., Somerfield, M. R., Schonberg, M. A., Boyd, C. M., Burhenn, P. S., Canin, B., Cohen, H. J., Holmes, H. M., Hopkins, J. O., Janelsins, M. C., Khorana, A. A., Klepin, H. D., Lichtman, S. M., Mustian, K. M., Tew, W. P., & Hurria, A.
- Affiliations
- City Of Hope National Medical Center (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2018-08-01
- Volume
- 36
- Issue
- 22
- Pages
- 2326-2347
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC6063790
- OpenAlex
- W2804780558
- Cited by
- 1,479
- References
- 179
- Citations by year
- 2026: 182 · 2025: 138 · 2024: 170 · 2023: 211 · 2022: 249 · 2021: 223 · 2020: 150 · 2019: 126 · 2018: 26
- FWCI
- 72.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (R21AG059206, K24AG056589, K24AG055693)
- National Cancer Institute (R01CA177592, UG1CA189961, P30CA008748)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- geriatric assessment, elderly patients, chemotherapy, geriatric oncology, comorbidity assessment, falls, depression screening, cognitive impairment, nutritional assessment, functional assessment, mortality prediction, life expectancy estimation, Geriatric Depression Scale, Mini-Cog, Geriatric 8, Vulnerable Elders Survey, caregiver involvement, treatment decision-making
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Female, Geriatrics, Humans, Male, Medical Oncology, Neoplasms, Geriatric Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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