Enhancing Geriatric Assessment in Cancer Rehabilitation: Suggestions for Future Research

Abstract

We would like to express our appreciation of the study by Brick et al. [1], which provides valuable insights into geriatric assessment (GA)-driven rehabilitation referrals among older adults with advanced cancer and explores their functional outcomes and survival. The researchers have addresses an important area in cancer rehabilitation, especially so for older adults with functional impairments. Nevertheless, as clinicians involved in gerontology, we would like to offer a few suggestions.

First, although the study used the OARS Comorbidity Scale to assess comorbidiy-associated impairment in the patients, it did not consider specific disease types. Multimorbidity is common in the geriatric population [2], and the healthcare priorities of patients may vary due to the need to manage chronic conditions. For example, patients requiring regular dialysis may be less likely to accept rehabilitation referrals.

Second, the researchers did not specifically consider patients with lymphoma. The study included patients with advanced solid malignant tumors or lymphoma, with the patients classified into three groups according to the cancer type, namely, gastrointestinal, lung, and other. Given the significant differences in treatment and prognosis between hematological and solid tumors [3], we recommend classifying patients with lymphoma as a single subgroup.

Third, the oncologists in the study may have had limited knowledge of GA. The study provided a summary of GA and recommendations to oncologists in the intervention arm [1]. However, these oncologists only received brief training in GA at the start of the study and thus may not have fully appreciated its importance. Moreover, they had the freedom to decide how to apply GA in the patients, and it is possible that different oncologists may have differed in their referral criteria, which could have led them to provide treatment recommendations essentially from an oncologist's perspective. We suggest that geriatricians should be involved in a collaborative process with oncologists and be available for consultation and answering their questions. Multidisciplinary collaboration is one of the critical principles in geriatric medicine [4].

Fourth, it might not be easy to generalize the study's findings. The results may not be suited to other countries or regions as the study was only conducted in the USA. Additionally, the study did not fully assess consistencies among different community oncology settings. Variations in healthcare resources, access to rehabilitation services, and clinical practices in different settings may influence the opportunities available to patients for rehabilitation, which could affect the generalization of the findings of this study.

Finally, the study did not account for the impact of the willingness of patients and their families to accept rehabilitation referrals. The researchers considered the social support, collecting data on income, marital status, living arrangements, education, and living situations of the participants, and conducted an assessment using the MOS scale. However, both referral for rehabilitation and service utilization may be influenced by the preferences and willingness of the patients and their families [5].

In conclusion, this study is excellent and impressive. We sincerely commend the researchers for their work and read the manuscript with great respect and enthusiasm. This innovative research highlights the potential value of rehabilitation for older adults with advanced cancer. Future studies on this topic would have worldwide relevance.

Qing Su: conceptualization, methodology, formal analysis, writing – original draft, writing – review and editing. Xiaofeng Zeng: conceptualization, methodology, writing – original draft, writing – review and editing.

The authors declare no conflicts of interest.