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Age is one factor doctors consider when planning cancer care and treatment. But it doesn¡¯t tell the whole story of a person¡¯s health, especially for older adults who have multiple health problems. While two 75-year-old people may have similar cancer diagnoses, how they tolerate cancer treatment can vary. And each person may hope for a different outcome from treatment.

¡°Cancer doesn¡¯t exist in isolation. Every person is different. It¡¯s important to know as much as we can about each person so we can develop the most personalized care plan to manage their cancer,¡± said Heidi Klepin, MD, MS, an expert and geriatric oncologist at Wake Forest School of Medicine.

As a key step toward meeting each person where they are, Dr. Klepin and other experts recommend that adults 65 and older who have cancer get a special checkup called a geriatric assessment. These assessments can help doctors and care teams understand individual differences when planning cancer care.

What is a geriatric assessment?

A geriatric assessment is a set of questions and a series of simple tests that look at different angles of an older adult¡¯s overall health. Together, these parts of a geriatric assessment consider the whole person, not just their diagnosis. For older people with cancer, this checkup often focuses on issues that may cause problems during cancer treatment. The assessment helps determine the status of a person¡¯s other health problems, too. It also considers their physical and mental well-being, support system, and personal goals and values related to their treatment options.

¡°This assessment is a holistic approach to really understand a person¡¯s health status. Many aspects of health can play into how someone tolerates a treatment and whether they will benefit from it,¡± said Dr. Klepin.

Regardless of a person¡¯s cancer status, the first part of a geriatric assessment is a survey completed by the older adult or their caregiver. It typically takes 5 to 10 minutes. Next, some simple assessments are done. They often include a walking test and a check of memory and thinking. These take a few minutes each.

¡°This assessment does not take a lot of time and effort. But the improvement in outcomes is quite remarkable,¡± said Dr. Klepin. ?¡°We have data showing that taking the time to gather this information and learn about each person in this holistic way helps doctors make decisions that improve outcomes for the patients. These decisions can decrease side effects and hospitalization risk and improve quality of life and satisfaction.¡±

What questions and tests does a geriatric assessment include?

A geriatric assessment gathers information about:

1. Strength and mobility: How easily can you stand, walk, and move around? How is your balance? The results can show if you¡¯re at risk for falls or injuries, especially if you have cancer-related fatigue.
2. Memory and thinking: The assessment uses simple questions to find out if your memory or focus needs support. Both skills are important for following care instructions that often include complex treatment schedules. They can also help with understanding how to manage side effects.
3. Medicines: The assessment reviews all your medicines, including prescriptions, over-the-counter drugs, and any vitamins or other supplements. This step helps identify medicines or supplements that may cause serious problems when combined with cancer therapy.
4. Nutrition and weight: Have you experienced recent weight loss or appetite loss? Eating well and maintaining a healthy weight gives your body the energy it needs to endure and recover from treatment.
5. Emotional health: The assessment checks for signs of depression or anxiety so support can be provided. Your emotional health can affect your physical and mental health, including what you eat, how tired you feel, how much information you can remember, and whether you stay on track with your care.
6. Social support: Do you have help with daily tasks and other needs, such as finding child care or getting rides to medical appointments? Your care team may be able to connect you with support and resources to help manage stress.
7. Personal goals and values: The assessment asks what matters most to you, such as staying independent or returning to a hobby. This information helps your care team recommend a treatment plan that supports your priorities and protects your quality of life.

How does a geriatric assessment help?

Managing underlying health issues can affect what cancer treatment you receive and how well it works. A geriatric assessment can help your doctor make recommendations that keep you on track with your treatment plan and goals.

The older adult population in the United States is growing quickly. A recent study suggests that as many as 90% of older adults with cancer also have at least one additional chronic illness.

Studies have shown that when older adults with cancer get a geriatric assessment, they have:

• Fewer severe side effects: Taking early steps to avoid harmful drug combinations and manage concerns like physical weakness and loss of appetite can help reduce problems during treatment.
• More successful treatment: When other health issues are managed, people are more likely to stay on track with their cancer treatment. Addressing concerns uncovered by a geriatric assessment may even help someone live longer.
• Improved quality of life: Research has shown that people who get a geriatric assessment say they feel better, stay more active, and maintain their independence during treatment.

What happens after a geriatric assessment?

Based on the results of the survey and tests, your doctor might recommend adding certain supportive care resources into your care plan. These often go beyond cancer medicine and include therapies and referrals that could benefit you. The care plan can also incorporate services such as transportation to appointments or help navigating insurance.

Does Medicare cover a geriatric assessment?

Medicare generally includes geriatric assessments for cancer care as part of an evaluation and management office visit. This means once your deductible is met, Medicare should pay 80% of the cost of the evaluation. Copays may apply with Medicare Advantage, so be sure to review your plan details in advance of your assessment.

Private insurance benefits for these assessments vary. Check with your insurance provider to find out which services they cover.

Talk to your care team

If you think you or a loved one may benefit from a geriatric assessment, the first step is to ask your health care team. ¡°This is something you should expect as the standard of care and that you have a right to ask for,¡± Dr. Klepin said.

If you are age 65 or older and starting cancer treatment, ask your doctor:

• Can you do a geriatric assessment for me? If not, how can I get one?
• What risks or side effects am I more likely to have because of my age or other health issues?
• How will my other medical conditions or medications affect my cancer treatment?
• How might a geriatric assessment affect the cancer treatment you recommend for me?
• What services are available in our community?
• What changes can I make right now to prepare me for cancer treatment?

¡°This sets a foundation for a much deeper relationship with your doctor,¡± said Dr. Klepin. ¡°We¡¯ve spent time to learn more about you and understand your values and what matters to you. We¡¯re able to explain that, based on all we¡¯ve assessed, we think you can tolerate this treatment and benefit from it, and that it will align with your goals.¡±

Learn more about cancer care from the ºÚÁÏ´óʪPosts Cancer Society:

• Making Treatment Decisions
• Daily Life and Supportive Care During Cancer Treatment
• Support Programs and Services

Dr. Klepin is a member of .