Comprehensive Assessment to Preserve Resilience in Older Adults With Cancer

OVERVIEW

Older adults have an increased risk of malignancy. Seniors often tolerate cancer treatment as well as younger people, depending on functional and general health status.

BACKGROUND

Cancer is most often diagnosed in people 65 years of age and older. Nurses must be aware of management options and some potential emergencies associated with the diagnosis and treatment of a malignancy.

PRINCIPLES OF CANCER CARE IN THE OLDER PERSON

A. Assess for comorbid conditions.

Cancer may be one of several chronic conditions.
The more severe the comorbidity, the lower the probability of survival after a diagnosis of cancer. The absence of severe comorbidity and good general health allow older people to be considered for more aggressive types of cancer treatments.

B. Assess the patient using a CGA.

A CGA is a battery of clinical measures used to assess functional, emotional, and cognitive status; falls; medications; and general health status.
Functional status can be measured using an Activities of Daily Living Scale, Instrumental Activities of Daily Living Scale, Gait Assessment Scale or Berg Balance Scale.
The risk of falls can be assessed using the Timed Up and Go Test.
Emotional status is often assessed using the eriatric Depression Scale.
Cognitive status is assessed using the Mini-Cog.
General health status is assessed with a complete history and physical exam.

C. Medication is evaluated using the Beers Medication Screen.

PARAMETERS OF ASSESSMENT

A. Older patients with cancer require comprehensive geriatric assessment and monitoring during diagnosis and treatment of malignancy.

ABBREVIATION

CGA comprehensive geriatric assessment

----

Updated: January 2025

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti, PhD, RN, FAAN, E.A., & Fulmer PhD, RN, FAAN, T. T. (2025). Evidence-Based Geriatric Nursing Protocols for Best Practice (7th ed.). Springer Publishing. Retrieved December 17, 2024, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826152763.html#tableofcontents

Chapter 35, Overcash, J. & Balducci, L. (2025) Comprehensive Assessment to Preserve Resilience in Older Adults With Cancer

REFERENCES

Annweiler, C., & Beauchet, O. (2015). Questioning vitamin D status of elderly fallers and nonfallers: A meta-analysis to address a “forgotten step.” Journal of Internal Medicine, 277(1), 16–44. https://doi.org/10.1111/joim.12250.Evidence Level I.

Balducci, L. (2013). Frailty: A common pathway in aging and cancer. Interdisciplinary Topics in Gerontology, 38, 61–72. https://doi.org/10.1159/000343586. Evidence Level V.

Balducci, L., Falandry, C., & List, A. (2022). New advances in supportive care: Chemoprotective agents as novel opportunities in geriatric oncology. Current Oncology Reports, 24(12), 1695–1703. https://doi.org/10.1007/s11912-022-01324-x.Evidence Level V.

Balducci, L., & Fossa, S. D. (2013). Rehabilitation of older cancer patients. Acta Oncologica, 52(2), 233–238. https://doi.org/10.3109/0284186x.2012.744142.Evidence Level V.

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry,4, 561–571. http://www.ncbi.nlm.nih.gov/pubmed/13688369. Evidence Level IV.

Beers, M. H. (1997). Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Archives of Internal Medicine, 157(14), 1531–1536. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9236554.Evidence Level I.

Berg, K. O., Wood-Dauphinee, S. L., Williams, J. I., & Maki, B. (1992). Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health, 83(Suppl 2), S7–S11. http://www.ncbi.nlm.nih.gov/pubmed/1468055. Evidence Level IV.

Borson, S., Scanlan, J., Brush, M., Vitaliano, P., & Dokmak, A. (2000). The mini-cog: A cognitive “vital signs” measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15(11), 1021–1027. https://doi.org/10.1002/1099-1166(200011)15:113.0.CO;2-6. Evidence Level IV.

Chau, B., LaGuardia, J., Hui, C., Ye, L., Xing, Y., Massarelli, E., & Amini, A. (2021). Narrative review of immunotherapy and radiation therapy in elderly patients. Translational Cancer Research, 10(5), 2620–2631. https://doi.org/10.21037/tcr-20-2637.Evidence Level V.

Cooper, L., Loewenthal, J., Frain, L. N., Tulebaev, S., Cardin, K., Hshieh, T. T., Dumontier, C., Streiter, S., Joseph, C., Hilt, A., Theou, O., Rockwood, K., Orkaby, A. R., & Javedan, H. (2022). From research to bedside: Incorporation of a CGA-based frailty index among multiple comanagement services. Journal of the American Geriatrics Society, 70(1), 90–98. https://doi.org/10.1111/jgs.17446. Evidence Level IV.

Dai, D., Coetzer, H., Zion, S. R., & Malecki, M. J. (2022). Multimorbidity and its associations with anxiety and depression among newly diagnosed patients with breast cancer: A retrospective observational cohort study in a US commercially insured and medicare advantage population. Cancer Control, 29, 10732748221140691. https://doi.org/10.1177/10732748221140691. Evidence Level IV.

de Glas, N., Bastiaannet, E., de Boer, A., Siesling, S., Liefers, G. J., & Portielje, J. (2019). Improved survival of older patients with advanced breast cancer due to an increase in systemic treatments: A population-based study. Breast Cancer Research and Treatment, 178(1), 141–149. https://doi.org/10.1007/s10549-019-05356-z Evidence Level IV.

Eamer, G., Taheri, A., Chen, S. S., Daviduck, Q., Chambers, T., Shi, X., & Khadaroo, R. G. (2018). Comprehensive geriatric assessment for older people admitted to a surgical service. Cochrane Database Systematic Reviews, 1(1), Cd012485. https://doi.org/10.1002/14651858.CD012485.pub2. Evidence Level I.

Enright, P. L., McBurnie, M. A., Bittner, V., Tracy, R. P., McNamara, R., Arnold, A., Newman, A. B., & Cardiovascular Health, S. (2003). The 6-min walk test: A quick measure of functional status in elderly adults. Chest, 123(2), 387–398. https://doi.org/10.1378/chest.123.2.387.Evidence Level IV.

Feliu, J., Heredia-Soto, V., Gironés, R., Jiménez-Munarriz, B., Saldaña, J., Guillén-Ponce, C., & Molina-Garrido, M. J. (2020). Management of the toxicity of chemotherapy and targeted therapies in elderly cancer patients. Clinical & Translational Oncology, 22(4), 457–467. https://doi.org/10.1007/s12094-019-02167-yEvidence Level V.

Franke, S., & Kulu, H. (2018). Mortality differences by partnership status in England and Wales: The effect of living arrangements or health selection? European Journal of Population,34(1), 87–118. https://doi.org/10.1007/s10680-017-9423-7Evidence Level V.

George, T., Shah, F., Tiwari, A., Gutierrez, E., Ji, J., Kuchel, G. A., Cohen, H. J., & Sedrak, M. S. (2022). Resilience in older adults with cancer: A scoping literature review. Journal of Geriatric Oncology, https://doi.org/10.1016/j.jgo.2022.07.009.Evidence Level V.

Hadley, E. C., Kuchel, G. A., & Newman, A. B. (2017). Report: NIA workshop on measures of physiologic resiliencies in human aging. Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 72(7), 980–990. https://doi.org/10.1093/gerona/glx015. Evidence Level VI.

Hamaker, M. E., Te Molder, M., Thielen, N., van Munster, B. C., Schiphorst, A. H., & van Huis, L. H. (2018). The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients—A systematic review. Journal of Geriatric Oncology. https://doi.org/10.1016/j.jgo.2018.03.014. Evidence Level I.

Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32(1), 50–55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x. Evidence Level IV.

Howlader, N., Noone, A. M., Krapcho, M., Miller, D., Brest, A., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., Lewis, D. R., Chen, H. S., Feuer, E. J., & Cronin, K. A. (2018). SEER cancer statistics review, 1975–2016. National Cancer Institute. https://seer.cancer.gov/csr/1975_2016/. Evidence Level IV.

Inwald, E. C., Kowalski, C., Wesselmann, S., Ferencz, J., & Ortmann, O. (2019). Recommendation of adjuvant trastuzumab treatment in HER-2-positive breast cancer patients: Insights from quality indicator data collected in certified breast cancer centers in Germany, Italy, Austria, and Switzerland. Archives of Gynecology and Obstetrics, 300(2), 383–388. https://doi.org/10.1007/s00404-019-05185-x. Evidence Level IV.

Jakovljevic, M., & Borovecki, F. (2018). Epigenetics, resilience, comorbidity and treatment outcome. Psychiatria Danubina, 30(3), 242–253. https://doi.org/10.24869/psyd.2018.242. Evidence Level IV.

Jobsen, J. J., van der Palen, J., Siemerink, E., & Struikmans, H. (2022). Limited impact of breast cancer and non-breast malignancies on survival in older patients with early-stage breast cancer: Results of a large, single-centre, population-based study. Clinical Oncology (Royal College of Radiologists), 34(6), 355–362. https://doi.org/10.1016/j.clon.2021.11.005. Evidence Level IV.

Justiz Vaillant, A., & Zito, P. (2022). Neutropenia in: StatPearls. StatPearls Publishing.

Katz, S., Downs, T. D., Cash, H. R., & Grotz, R. C. (1970). Progress in development of the index of ADL. Gerontologist, 10(1), 20–30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=5420677. Evidence Level IV.

Lancellotta, V., Kovács, G., Tagliaferri, L., Perrucci, E., Colloca, G., Valentini, V., & Aristei, C. (2018). Age is not a limiting factor in interventional radiotherapy (brachytherapy) for patients with localized cancer. Biomed Research International, 2018, 2178469. https://doi.org/10.1155/2018/2178469. Evidence Level V.

Lawton, M., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9(3), 179–186. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=5349366. Evidence Level IV.

Lee, Y. H., Oh, H. K., Kim, D. W., Ihn, M. H., Kim, J. H., Son, I. T., Kang, S. I., Kim, G. I., Ahn, S., & Kang, S. B. (2016). Use of a comprehensive geriatric assessment to predict short-term postoperative outcome in elderly patients with colorectal cancer. Annals of Coloproctology,32(5), 161–169. https://doi.org/10.3393/ac.2016.32.5.161. Evidence Level IV.

Maciejewski, M. L., & Hammill, B. G. (2019). Measuring the burden of multimorbidity among medicare beneficiaries via condition counts and cumulative duration. Health Services Research,54(2), 484–491. https://doi.org/10.1111/1475-6773.13124Evidence Level IV.

Mohile, S. G., Dale, W., Somerfield, M. R., Schonberg, M. A., Boyd, C. M., Burhenn, P. S., Canin, B., Cohen, H. J., Holmes, H. M., Hopkins, J. O., Janelsins, M. C., Khorana, A. A., Klepin, H. D., Lichtman, S. M., Mustian, K. M., Tew, W. P., & Hurria, A. (2018). Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. Journal of Clinical Oncology, 36(22), 2326–2347. https://doi.org/10.1200/jco.2018.78.8687. Evidence Level VI.

Mohile, S. G., Epstein, R. M., Hurria, A., Heckler, C. E., Canin, B., Culakova, E., Duberstein, P., Gilmore, N., Xu, H., Plumb, S., Wells, M., Lowenstein, L. M., Flannery, M. A., Janelsins, M., Magnuson, A., Loh, K. P., Kleckner, A. S., Mustian, K. M., Hopkins, J. O., … Dale, W. (2020). Communication with older patients with cancer using geriatric assessment: A cluster-randomized clinical trial from the national cancer institute community oncology research program. JAMA Oncology, 6(2), 196–204. https://doi.org/10.1001/jamaoncol.2019.4728. Evidence Level II.

Overcash, J., Fugett, S., Tan, A., Ginther, J., & Williams, N. (2019). Strain among caregivers of older adults diagnosed with breast cancer. Oncology Nursing Forum, 46(6), E185–E201. https://doi.org/10.1188/19.ONF.E185-E201

Parker, S. G., McCue, P., Phelps, K., McCleod, A., Arora, S., Nockels, K., Kennedy, S., Roberts, H., & Conroy, S. (2018). What is Comprehensive Geriatric Assessment (CGA)? An umbrella review. Age and Ageing, 47(1), 149–155. https://doi.org/10.1093/ageing/afx166. Evidence Level V.

Podsiadlo, D., & Richardson, S. (1991). The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142–148. http://www.ncbi.nlm.nih.gov/pubmed/1991946Evidence Level IV.

Prochaska, M. T., Newcomb, R., Block, G., Park, B., & Meltzer, D. O. (2017). Association between anemia and fatigue in hospitalized patients: Does the measure of anemia matter? Journal of Hospital Medicine, 12(11), 898–904. https://doi.org/10.12788/jhm.2832Evidence Level IV.

Puts, M., Alqurini, N., Strohschein, F., Koneru, R., Szumacher, E., Mariano, C., Monette, J., Hsu, T., Brennenstuhl, S., McLean, B., Wills, A., Berger, A., Amir, E., Romanovsky, L., Li, A., Mehta, R., Krzyzanowska, M., Elser, C., Jang, R., … Alibhai, S. M. H. (2022). Impact of geriatric assessment and management on quality of life, unplanned hospitalizations, toxicity, and survival for older adults with cancer: The randomized 5C trial. Journal of Clinical Oncology, JCO2201007. https://doi.org/10.1200/JCO.22.01007. Evidence Level II.

Schulkes, K. J., Souwer, E. T., Hamaker, M. E., Codrington, H., van der Sar-van der Brugge, S., Lammers, J. J., Portielje, J. E., van Elden, L. J., & van den Bos, F. (2017). The effect of a geriatric assessment on treatment decisions for patients with lung cancer. Lung, 195(2), 225–231. https://doi.org/10.1007/s00408-017-9983-7. Evidence Level IV.

Sedrak, M. S., Gilmore, N. J., Carroll, J. E., Muss, H. B., Cohen, H. J., & Dale, W. (2021). Measuring biologic resilience in older cancer survivors. Journal of Clinical Oncology, 39(19), 2079–2089. https://doi.org/10.1200/JCO.21.00245. Evidence Level V.

SEER. (2022). SEER cancer stat facts: Cancer of any site. https://seer.cancer.gov/statfacts/html/all.html. Evidence Level V.

Simmonds, M. J. (2002). Physical function in patients with cancer: Psychometric characteristics and clinical usefulness of a physical performance test battery. Journal of Pain and Symptom Management, 24(4), 404–414. https://doi.org/10.1016/s0885-3924(02)00502-x. Evidence Level IV.

Soto-Perez-de-Celis, E., Li, D., Yuan, Y., Lau, Y. M., & Hurria, A. (2018). Functional versus chronological age: Geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol, 19(6), e305–e316. https://doi.org/10.1016/s1470-2045(18)30348-6.Evidence Level V.

Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA, 282(18), 1737–1744. https://doi.org/10.1001/jama.282.18.1737.Evidence Level IV.

Tinetti, M. E. (1986). Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society, 34(2), 119–126. https://doi.org/10.1111/j.1532-5415.1986.tb05480.x.Evidence Level IV.

Treanor, C. J. (2020). Psychosocial support interventions for cancer caregivers: Reducing caregiver burden. Current Opinion in Supportive and Palliative Care, 14(3), 247–262. https://doi.org/10.1097/SPC.0000000000000508.Evidence Level V.

Vallet-Regi, M., Manzano, M., Rodriguez-Manas, L., Checa Lopez, M., Aapro, M., & Balducci, L. (2017). Management of cancer in the older age person: An approach to complex medical decisions. Oncologist, 22(3), 335–342. https://doi.org/10.1634/theoncologist.2016-0276. Evidence Level V.

Van Ancum, J. M., Tuttle, C. S. L., Koopman, R., Pijnappels, M., Meskers, C. G. M., Paul, S. K., & Maier, A. B. (2022). Albumin and C-reactive protein relate to functional and body composition parameters in patients admitted to geriatric rehabilitation after acute hospitalization: Findings from the RESORT cohort. European Geriatric Medicine, 13(3), 623–632. https://doi.org/10.1007/s41999-022-00625-5. Evidence Level IV.

Volkel, V., Draeger, T., Schnitzbauer, V., Gerken, M., Benz, S., Klinkhammer-Schalke, M., & Furst, A. (2019). Surgical treatment of rectal cancer patients aged 80 years and older-a German nationwide analysis comparing short- and long-term survival after laparoscopic and open tumor resection. European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2019.05.005 Evidence Level III.

Wesa, K. M., Segal, N. H., Cronin, A. M., Sjoberg, D. D., Jacobs, G. N., Coleton, M. I., Fleisher, M., Dnistrian, A. M., Saltz, L. B., & Cassileth, B. R. (2015). Serum 25-hydroxy vitamin D and survival in advanced colorectal cancer: A retrospective analysis. Nutrition and Cancer, 67(3), 424–430. https://doi.org/10.1080/01635581.2015.998838. Evidence Level IV.

Williams, G. R., Dai, C., Giri, S., Al-Obaidi, M., Harmon, C., Kenzik, K. M., McDonald, A., Gbolahan, O., Outlaw, D., Khushman, M., Richman, J., & Bhatia, S. (2022). Geriatric assessment predictors of 1-year mortality in older adults with GI malignancies: A survival tree analysis. Journal of Clinical Cancer Informatics, 6, e2200065. https://doi.org/10.1200/cci.22.00065. Evidence Level IV.

Williams, G. R., Deal, A. M., Lund, J. L., Chang, Y., Muss, H. B., Pergolotti, M., Guerard, E. J., Shachar, S. S., Wang, Y., Kenzik, K., & Sanoff, H. K. (2018). Patient-reported comorbidity and survival in older adults with cancer. Oncologist,23(4), 433–439. https://doi.org/10.1634/theoncologist.2017-0404.Evidence Level IV.

Woelfel, I. A., Fernandez, L. J., Idowu, M. O., & Takabe, K. (2018). A high burden of comorbid conditions leads to decreased survival in breast cancer. Gland Surgery, 7(2), 216–227. https://doi.org/10.21037/gs.2018.02.03. Evidence Level IV.

World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). https://www.who.int/classifications/international-classification-of-functioning-disability-and-health. Evidence Level I.

Xue, D. D., Cheng, Y., Wu, M., & Zhang, Y. (2018). Comprehensive geriatric assessment prediction of postoperative complications in gastrointestinal cancer patients: A meta-analysis. Clinicals Intervention in Aging, 13, 723–736. https://doi.org/10.2147/cia.s155409.Evidence Level I.

Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatry Research, 17(1), 37–49. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7183759. Evidence Level IV.

Zeng, W., Wu, X., Xu, Y., Wu, J., Zeng, Y., Shao, J., Huang, D., & Zhu, Z. (2021). The impact of general self-efficacy on psychological resilience during the COVID-19 pandemic: The mediating role of posttraumatic growth and the moderating role of deliberate rumination. Frontiers in Psychology, 12, 684354. https://doi.org/10.3389/fpsyg.2021.684354. Evidence Level IV.Annweiler, C., & Beauchet, O. (2015). Questioning vitamin D status of elderly fallers and nonfallers: A meta-analysis to address a “forgotten step.” Journal of Internal Medicine, 277(1), 16–44. https://doi.org/10.1111/joim.12250.Evidence Level I.