Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

The impact of comprehensive geriatric assessment on treatment decisions, care received, and postoperative outcomes in older adults with cancer undergoing surgery: a systematic review (#452)

Domenica Disalvo 1 , Maja Garcia 1 , Heather Lane 2 , Wee-Kheng Soo 3 4 5 , Elise Treleaven 6 , Gordon McKenzie 7 , Tim To 8 9 , Jack Power 1 , Jane Phillips 10 , Meera Agar 1
  1. IMPACCT – Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Ultimo, NSW, Australia
  2. Rockingham General Hospital, Fremantle, WA, Australia
  3. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
  4. Cancer Services, Eastern Health, Melbourne, Victoria, Australia
  5. Department of Aged Medicine, Eastern Health, Melbourne, Victoria, Australia
  6. Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
  7. Hull York Medical School, University of Hull, Hull, United Kingdom
  8. Division Rehabilitation, Aged Care and Palliative Care, Flinders Medical Centre, Bedford Park, SA, Australia
  9. College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
  10. School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia

Introduction: Surgery is an essential part of multimodal treatment of solid tumours, but frail older patients are at increased risk of postoperative complications. Geriatric assessments (GA) with tailored interventions or comprehensive geriatric assessments (CGA) can identify the frailty factors and needs of older adults with cancer intended for surgery, thereby assisting with treatment decision-making and implementation of supportive care strategies to reduce postoperative complications and enhance recovery after surgery.

Aim: This systematic review aims to summarise the effects of GA/CGA compared to usual care for older adults with cancer intended for surgery, and its impact on treatment decisions, supportive care interventions, postoperative complications, survival and health-related quality of life (HRQOL).

Method: A systematic search of MEDLINE, EMBASE, CINAHL and PubMed was conducted to include studies from January 2017 to October 2022, to identify randomised controlled trials or prospective cohort comparison studies on the effects of GA/CGA of older adults with cancer intended for surgery, and its impact on outcomes of interest.

Results: Eleven studies reporting on ten trials were included for analysis. Two randomised trials found preoperative GA/CGA did not significantly reduce the incidence of postoperative delirium, Clavien-Dindo grade II-V complications, hospital length of stay, readmissions, reoperations, mortality, or most geriatric domains, nor reduce or stabilise care dependency postoperatively compared to usual care. There was marginal benefit in some domains of HRQOL, such as total pain, but the clinical implications are unclear. There was a statistically significant difference in favour of the intervention for reducing the total number of Grade I-V complications, due to fewer Grade I-II complications, which were primarily medical rather than geriatric-focused.

Conclusion: Future research to endeavour to develop well powered high-quality trials to determine the impact of CGA on treatment decision-making, the supportive care pathway and postoperative surgical outcomes in older adults with cancer.