Leana Cabrera Chien and William Dale Underscore The Value of Geriatric Assessments in Optimizing Cancer Care

In this episode of The Vitals, Oncology Nursing News® spoke with Leana Cabrera Chien, MSN, RN, GCNS-BC, GNP-BC, and William Dale, MD, PhD. The pair discuss the value of geriatric assessments in optimizing cancer care for older adults, especially considering the recent update to the American Society of Clinical Oncology (ASCO) guidelines, stating that all patients with cancer who are older than 65 years should receive a geriatric assessment.¹

The update emphasizes the overarching recommendations from the previous guidelines, except that the new guidelines are based on data which suggest that geriatric assessments can improve patient outcomes and are therefore a critical component of quality care.

Both Cabrera Chien, who is a nurse practitioner in the Center for Cancer and Aging at City of Hope, and Dale, who is vice chair for academic affairs in the Department of Supportive Care Medicine at City of Hope, as wellthe director of City of Hope’s Center for Cancer and Aging, were investigators on the pivotal GAIN trial (NCT02517034), which was one of the large randomized clinical trials that supported the ASCO guideline update.^2,3 The findings from this research demonstrated that when patients undergoing chemotherapy receive geriatric assessments, they experienced fewer treatment-related toxicities—preserving quality of life—without affecting survival outcomes. According to these specialists, geriatric assessments also improve patient and caregiver satisfaction, communication surrounding aging concerns, and the completion of advanced directives.

Episode Highlights

“The importance of the GA is how it is individualized with each patient.” Time stamp (TS) 4:42

“Since this visit, she has written to us and told us how thankful she is for the care she received at City of Hope. Utilizing the GA really [helped us] find out what this patient needed, and we met that need” TS 7:38

“When we developed the PGA, we asked a lot of nurses, because we knew that they were going to be the key to giving us the real-time, real-world implementation guidance that would be needed to take these academic studies like GAIN and put them into the actual practice.” TS 10:00

Oncology Nursing News Articles:

• ASCO States That All Older Adults With Cancer Should Receive Geriatric Assessments
• Geriatric Assessment Intervention Helps Reduce Symptom Burden for Older Patients With Advanced Cancer
• Geriatric Assessment Rates Improve With Nurse Navigator Intervention
• Geriatric Assessments Help Promote Comorbidity-Related Discussions in Patients With Advanced Cancer

Video Interviews:

• Supriya Mohile on Lack of Representation of Geriatric Patients in Clinical Trials
• Claire Friedman on Considerations for Older Patients Receiving Immunotherapy

Podcast Episodes:

• Preparing Nurses for the 'Silver Tsunami'
• Behind Integrated Behavioral Health Services

References

1. Dale W, Klepin HD, Williams GR, et al. Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline update. J Clin Oncol. Published online July 17, 2023. doi:10.1200/JCO.23.00933
2. Li D, Sun CL, Kim H, et al. Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: a randomized clinical trial. JAMA Oncol. 2021;7(11):e214158. doi:10.1001/jamaoncol.2021.4158
3. Mohile SG, Mohamed MR, Xu H, et al. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet. 2021;398(10314):1894-1904. doi:10.1016/S0140-6736(21)01789-X