Background: Older adults with cancer may present with multimorbidity or vulnerabilities, making treatment decisions complex and challenging. Under- and over-treatment can have adverse outcomes for older cancer patients. Geriatric assessments (GAs) can guide treatment decision-making and identify issues that may not otherwise be captured, however are not routinely conducted in cancer care. The aim of this umbrella review was to summarise and synthesise the evidence for i) what constitutes a GA in cancer care, ii) how GAs are conducted, iii) which outcomes are used to assess the efficacy of GAs and iv) how implementation of GAs in cancer settings are reported.
Methods: Six electronic databases were searched: PsycINFO, MEDLINE, Embase, CINAHL, Cochrane Library and Web of Science. Eligible reviews included systematic reviews that i) described the use or value of GAs for older adults with cancer, or ii) information related to GA implementation in cancer settings. Two reviewers reviewed articles for eligibility; data was extracted, and quality appraisal was conducted. The review was registered with PROSPERO:CRD42022338842.
Results: Thirty-seven reviews were included in the umbrella review. A GA was commonly defined as a systematic, multi-dimensional evaluation of an older person, although the number and types of domains assessed within a GA differed. Of the seventeen reviews that reported when the GA was conducted, most reported GAs occurred prior to commencing treatment. Twelve reviews reported who conducted the GAs, this varied within and across reviews and included the patient themselves, a multi-disciplinary team, nurse or cancer specialists or geriatrician-led consultation or assessments. Ten reviews reported interventions provided or recommended to patients following a GA. Reported outcomes included mortality/survival (22/37 reviews), treatment toxicity (17/37 reviews) and peri-operative complications (15/37 reviews), delivery of care, specifically treatment completion (11/37 reviews) and treatment modification (11/37 reviews) and resource-related outcomes (11/37 reviews). Four reviews reported barriers and enablers to GA implementation, although the extent to which this was discussed varied with only two reviews specifying implementation or integration as an aim within their review. Four reviews briefly described feasibility of the GA, mostly assessed through patient acceptability of self-administered or computer-based assessments.
Conclusion: There is a need for standardised definition of what constitutes a GA to facilitate evidence-based research and adoption of implementation principles to ensure implementation of GAs as part of routine cancer care.