Bridging the Gap: Geriatric Assessment vs Routine Provider Evaluation in Gastroesophageal Cancer Care

Efrat Dotan, MD

Routine provider assessment for geriatric patients with gastroesophageal cancer identified fewer geriatric abnormalities compared with geriatric assessment in all domains except in comorbidities, according to data from a retrospective study presented during the 2024 Genitourinary Cancers Symposium.¹

Investigators evaluated the utility of the geriatric assessment in terms of identifying abnormalities in these patient populations that may affect patient care compared with the use of provider assessment, showing that the geriatric assessment identified more abnormalities than provider assessment in most evaluated domains (n = 82). This includes functional status (physician assessment detected, 1%; geriatric assessment detected, 33%), nutrition (2%; 48%), psychological status (7%; 28%), cognition (0%; 9%), social support (2%; 32%), and chemotherapy toxicity risk (2%; 35%).

Furthermore, the geriatric assessment identified abnormalities in these patients that can affect treatment outcomes that went undetected by routine provider assessment. Notably, the patients’ demographics and characteristics did not influence the identification of abnormalities.

“It is important to think beyond the treatment you're prescribing,” study co-author, Efrat Dotan, MD, said in an interview with OncLive. “Think about all the factors that are affecting your patients, whether it's social support, cognitive function, polypharmacy, functional status, comorbidities, or other things that really have direct implication on how they're going to tolerate their treatment.”

In the interview, Dotan discussed the evaluation of routine provider assessment vs the utility of geriatric assessment in geriatric patients undergoing anti-cancer therapy for gastroesophageal disease, emphasized the need for providers to be aware of the unique needs that geriatric patients with cancer require when undergoing treatment, and highlighted the importance of initiating more trials to identify barriers related to cancer care in older patients.

Dotan is the chief of the Division of Gastrointestinal Medical Oncology, an associate professor in the Department of Hematology/Oncology, and the associate director of the Hematology/Oncology Fellowship Training Program, at Fox Chase Cancer Center, Temple Health, in Philadelphia, Pennsylvania.

OncLive: Please expand on your evaluation of routine clinical assessment of older adults with gastroesophageal cancer.

Dotan: We did a study looking at older patients with gastric or gastroesophageal cancer. Our study aimed to understand the needs of these very vulnerable patients who are faced with issues related to their aging, as well as a very aggressive cancer and therapy for an aggressive cancer.

In our research, we looked at the benefit of using a geriatric assessment to identify those issues that patients are facing and compare that to what physicians typically do in their practice.

What was revealed when evaluating the utility of the geriatric assessment compared with routine provider assessment?

Our study has shown that there was a huge discrepancy between what the geriatric assessment found vs what the physician identifies in clinic. [These included] issues related to psychosocial support, cognition, and function status which were identified [by the assessment, even though] the physicians did not identify any of these challenges that the patients are facing.

The physicians were very good at identifying comorbidities, but not at understanding the other factors that affect the patient. Furthermore, when we looked at outcomes, there was a clear correlation between these unidentified abnormalities and high rates of toxicities from treatment, high rates of hospitalization, and other complications.

Therefore, I think the study highlights how, as providers caring for these vulnerable patients, we have to think beyond what treatment to give them, and instead look at them more holistically, thinking about everything that they're facing in their cancer journey.

How do these findings help to understand what unmet needs currently stand in the clinic?

These findings are what we anticipated; however, it does help us really understand where the needs are. What areas are really miss evaluated or unevaluated by providers? [This research] shows us that we really need to think more, or we need to pay more attention when we're evaluating patients.

How did you aim to expand this research?

Another aspect of this trial, which was an exploratory analysis that was performed, was we had our older patients wear a Fitbit for [4] days, and we tried to get an objective assessment of their function.² We were able to have that in 85% of our patients who were able to complete that task, and wear the Fitbit for [4] days.

We were able to come up with a median number of steps per day, which correlated with outcome. If a patient is [only walks] approximately 2500 steps per day, that really stands out as a challenge and something that would clearly affect outcomes vs patients who were much more active and walked more.

What prompted this exploratory analysis?

The idea behind that exploratory analysis was to see if we can come up with a more objective way to evaluate these patients rather than questionnaires that are sometimes potentially biased by other factors or challenging to apply in clinic. I hope this study will add to the growing evidence that we need as clinicians taking care of older patients, and we see a lot of older patients in our clinic.

We really need to think about their full picture and everything that affects their care, not just the cancer itself, the drug we give them and the labs. We need to think of the more comprehensive picture that affects what happens to them.

How are you hoping that these unmet needs for patients will be addressed moving forward?

There are a few studies that have come out in recent years showing the benefit of doing a geriatric assessment, the benefit of geriatric assessment-guided care. This encompasses evaluating the patients, understanding their needs, and addressing them as you're delivering the oncologic treatment.

As we see more trials identifying barriers incorporated into practice, and we develop easier ways to incorporate this type of assessment, I hope that we will see improvement in outcomes in older patients. This is so we can provide them with the support and quality of life that they need during their treatments.

What would you like your colleagues to take away from this research?

We must also think about what kind of AEs or complications patients are going to have, and their ultimate outcomes. When you think about the full picture, you will automatically identify these abnormalities and potentially address them before they cause harm.

References

1. Connors M, Meeker CR, Handorf, E, et al. Does routine clinical assessment of older adults with gastroesophageal cancer tell the whole story? J Clin Oncol. 2024;42(suppl 3):297. doi:10.1200/JCO.2024.42.3_suppl.297
2. Ward WH, Meeker CR, Handorf, E, et al. Feasibility of fitness tracker usage to assess activity level and toxicities in patients with colorectal cancer. J Clin Oncol. 2020;38 (suppl 4). doi:10.1200/JCO.2020.38.4_suppl.9