Geriatric Assessment-Guided Care for Older Adults with Cancer: A Clinical Practice Review

Abstract

Cancer is a growing global health burden among older adults, with incidence rising most rapidly in low- and middle-income countries. Chronological age alone poorly reflects physiological reserve, comorbidity, frailty, and functional status, which together determine how well an older patient tolerates cancer therapy. This clinical practice review summarizes contemporary geriatric oncology approaches based on international consensus guidelines and current literature. Comprehensive geriatric assessment (CGA), evaluating functional status, comorbidity, falls, cognition, mood, nutrition, polypharmacy, and social support, outperforms performance status alone in predicting chemotherapy toxicity, treatment completion, functional decline, and mortality. Beyond prognostication, randomized trials have shown that geriatric assessment-guided management reduces severe chemotherapy toxicity and improves communication about ageing-related concerns without compromising survival, which is the strongest argument for embedding assessment into routine oncology care. Validated brief screening tools such as the Geriatric-8 (G8) can identify patients who warrant full assessment, and chemotherapy toxicity calculators such as the Cancer and Aging Research Group and Chemotherapy Risk Assessment Scale for High-Age Patients scores improve risk estimation and support shared decision-making. Implementation remains the principal barrier in resource-limited settings, where geriatrician availability, clinic time, and reimbursement constrain routine use; pragmatic adaptations include nurse-led or self-administered assessment and stepwise screening pathways. Geriatric assessment-guided multidisciplinary care, adapted to local resources, should be regarded as the standard of care for older adults with cancer rather than an optional refinement, and deserves explicit incorporation into national cancer control planning.