# Geriatric assessment by default for every patient over 70 starting cancer treatment

Source: https://onco.cc/ideas/idea-acc-geriatric-assessment-by-default/  
OnCo record `idea-acc-geriatric-assessment-by-default` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A short structured check of memory, mobility, nutrition and medicines before treatment cuts serious side effects in older patients without reducing benefit. It should be automatic, not optional.

## Summary

Randomised trials (GAP70+, GAIN, and others) showed that geriatric assessment with management recommendations reduces grade 3 or higher toxicity in older patients receiving chemotherapy, and ASCO guidelines recommend it. Uptake remains low because it is seen as extra work. Embedding a validated screening tool (such as G8) in intake, with automatic full assessment and management recommendations for positive screens, delivered by nurses, would make it the default.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Tags: protocol-upgrade; upgrade:proven-unevenly-used; evidence:strong; precision
- Hypothesis: Default geriatric assessment will reduce grade 3 or higher treatment toxicity in patients over 70 by at least 20% and reduce unplanned admissions, without reducing treatment completion for curative-intent therapy.
- Rationale: Level 1 evidence of benefit exists; the failure is implementation, which defaults address.
- Proposed test: A stepped-wedge implementation across 20 centres with toxicity, admissions, treatment completion, and functional decline at six months as endpoints.
- Maturity: being-tested-at-scale
- Actor: clinic

## Notes

- Protocol upgrade, graded proven but unevenly used. GAP70+ cluster-randomised 40 community practices and 718 patients aged 70 or over: grade 3 to 5 toxic effects occurred in 51 per cent with a geriatric assessment summary and management recommendations against 71 per cent with usual care (relative risk 0.74), with fewer falls. GAIN randomised 613 patients aged 65 or over at one centre: grade 3 or higher chemotherapy toxicity was 50.5 per cent against 60.6 per cent, with no difference in overall survival. ASCO's 2023 update reiterates that geriatric assessment should be used for older patients starting systemic therapy.
- Adoption gap, as measured: in a 2019 to 2020 survey of 349 United States oncologists, 60 per cent did not use a formal geriatric assessment for any of their older patients, most often calling it too cumbersome (44 per cent) or of no added value (36 per cent) (Gajra, 2022). In four French centres, 51 of 131 men with metastatic prostate cancer and an indication for geriatric assessment before docetaxel received one (38.9 per cent), the commonest barrier being the absence of systematic screening (GAMERS, 2023).

## Sources

- Li et al., Geriatric Assessment-Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer (JAMA Oncol 2021): https://doi.org/10.1001/jamaoncol.2021.4158
- Mohile et al., Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology (J Clin Oncol 2018): https://doi.org/10.1200/JCO.2018.78.8687
- Dale et al., Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update (J Clin Oncol 2023): https://doi.org/10.1200/JCO.23.00933
- Gajra et al., The Use and Knowledge of Validated Geriatric Assessment Instruments Among US Community Oncologists (JCO Oncol Pract 2022): https://doi.org/10.1200/OP.21.00743
- Gluszak et al., Geriatric Assessment Implementation before Chemotherapy in Metastatic Prostate Cancer: the GAMERS study (J Clin Med 2023): https://doi.org/10.3390/jcm12041636
- GAP70+ trial (Mohile et al., Lancet 2021): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01789-X/fulltext

## Connected records

- ideas: [An automatic electronic frailty index inside the oncology record](https://onco.cc/ideas/idea-acc-electronic-frailty-index-oncology/), [Geriatric assessment by default for every older patient, and trials that admit them](https://onco.cc/ideas/idea-moon-geriatric-assessment-default/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [G8 geriatric screening tool](https://onco.cc/technologies/g8-geriatric-screening/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/)
- bottlenecks: [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth](https://onco.cc/key-papers/paper-gap70-geriatric-assessment-lancet-2021/), [Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology](https://onco.cc/key-papers/paper-mohile-j-clin-oncol/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

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