Comparison of geriatric assessment with provider's clinical assessment among older adults with gastroesophageal cancer.

Abstract

Background: Older adults with gastroesophageal cancer (GEC) frequently visit oncology practices, but provider assessments often overlook critical geriatric factors. This study compares the effectiveness of a geriatric assessment (GA) versus routine provider assessment (PA) in evaluating these patients.

Methods: Patients (≥ 65 years) actively undergoing therapy for GEC completed a GA, while providers conducted a baseline PA. Both assessments identified abnormalities across multiple geriatric domains, including functional status, nutrition, comorbidities, psychological distress, cognition, social support, and chemotherapy toxicity risk. We compared abnormalities detected and their correlation with clinical outcomes (≥ grade 3 toxicity and hospitalization) at 3 months.

Results: Among 82 patients, 89% had at least one severe abnormality. GA identified more severe abnormalities (53%) than PA (35%), particularly in nutrition, psychological status, social support, and cognition. PA was more effective in detecting patients with comorbidities impacting treatment (49 vs. 20 patients). Patients with high chemotherapy toxicity scores and psychosocial distress had greater toxicity risk, while severe abnormalities in function, nutrition, and psychological status were linked to increased risk of hospitalization.

Conclusions: Geriatric assessment uncovers significant geriatric abnormalities that are often missed by PA in older adults with GEC. Findings support integrating GA into routine evaluations to improve patient care.

Implications for practice: Older adults with gastroesophageal cancers (GEC) represent a vulnerable and under-assessed population in oncology. This study demonstrates that geriatric assessment (GA) detects significantly more clinically relevant abnormalities-particularly in nutrition, psychosocial support, cognition, and chemotherapy toxicity risk-than routine provider assessments. These findings are particularly timely as gastroesophageal cancer therapy enters an era of increasingly complex and potentially toxic treatments, including antibody-drug conjugates and combination regimens. With nearly 90% of patients in our study presenting with at least one severe abnormality requiring intervention, GA offers a practical and evidence-based tool to improve treatment decision-making, minimize toxicities, and personalize care for older adults. Incorporating GA into routine oncology practice is essential to optimizing outcomes and ensuring equitable care delivery for this growing patient population.