Geriatric assessment (GA) and the influence on the variability of treatment recommendations for elderly patients (pts) with gastrointestinal (GI) tumors.
Authors: Buettelmann Moritz , Hofheinz Ralf Dieter , Kroecher Anke , Ubbelohde Ulrike , Stintzing Sebastian , Reinacher-Schick Anke C. , Bornhäuser Martin , Folprecht Gunnar 
Published: June 2022

12049

Background: GA is recommended to guide therapy for elderly cancer pts. To assess whether GA results influence the recommended treatment and the inter-oncologist variability of treatment recommendations, we conducted a case-vignette-based study in medical oncologists (MOs). Methods: MOs were asked to give medical treatment recommendations for GI cancer pts in three steps: (1) based on tumor findings alone to simulate the guideline recommendation for a “50-year-old standard patient (pat.) without comorbidities”, (2) for the same tumor situation in an elderly pat. according to the medical history, comorbidities, lab values and a short video simulating the clinical consultation situation and (3) after in addition the results of a full GA were disclosed (Barthel index, Cumulative Illness Rating Scale, G8, Geriatric Depression Scale, Mini Mental Status Examination, Mini-Nutritional-Assessment [MNA], Time Get Up and Go, EORTC-QLQ30 and stair climb test - each with short interpretation aid). Each MO voted for 2-4 randomly allocated pts out of a pool of 10 pts with mean age 78.5 years. A slider (like a visual analogue scale) was used to express the grade of recommendation for several treatment options per patient. The means and variances for each treatment option were calculated and compared for analysis. Results: Seventy German MOs had given 164 treatment recommendations that were substantially different for elderly compared to younger pts. The recommendations had a significantly higher variance for elderly pts than for the “standard” pts (p < 0.0001) indicating a lower inter-oncologist agreement regarding the treatment recommendations in elderly pts. MOs with > 6 years working experience as specialist had no lower variance in their recommendations. There was a non-significant trend towards a lower variance if the MOs were based at outpatient units of hospitals (compared to MOs working with in-patients or as private oncologists) and for MOs working at larger hospitals (> 800 beds) compared to those based at smaller ones. The knowledge on the full GA results had marginal influence on the treatment recommendations itself or its variance, only (p = 0.92). In the survey, the geriatric tools were rated more than two times higher as being meaningful (53%) and useful (49%) than they were used in clinical practice (19%). The most used tool in the routine care for geriatric pts was the MNA (30%). Conclusions: There is a large variability regarding the "optimal" treatment in geriatric pts without meaningful improvement with larger working experience. Although the recommended therapeutic regime varied in elderly pts and the MOs rated the GA results as “useful”, the GA results did not influence the individual recommendations or its variance, and GA is rarely used in daily practice indicating that more research on an effective implementation into the clinical practice is needed.