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Purpose Older adults with head and neck cancer have increased postoperative complications, longer hospital stays, and higher rates of mortality. Geriatric assessment (GA) provides a measure of overall health status and is preferable to using age alone for assessing fitness for surgery. We sought to determine whether a patient's frailty as determined by a novel electronic GA is associated with outcomes after head and neck cancer (HNC) surgery. Methods We conducted a retrospective review of 159 patients aged 75 and older referred to the Geriatrics Service at Memorial Sloan Kettering Cancer Center for pre-operative evaluation prior to undergoing HNC surgery. All patients completed the electronic Rapid Fitness Assessment (eRFA) within 60 days prior to surgery. The accumulated geriatric deficit (AGD) score includes twelve domains from the eRFA with a point assigned for each domain in which there is a deficit and a final point related to comorbidities. Three other metrics were individually assessed: age, Karnofsky Performance Scale (KPS), and number of comorbidities. We utilized multivariable linear regression and t-tests to determine whether frailty is associated with longer length of hospital stay, 30-day intensive care unit (ICU) admission, and 30-day and 90-day postoperative mortality. Results Patients with a higher AGD score spent more time in the hospital post-operatively (1.0 day increase per unit increase in AGD; 95% CI: 0.21–1.9; p = 0.015). Lower KPS was also associated with statistically significant longer length of stay (−2.70 day change per increasing index KPS; 95% CI: −4.30 – −1.00; days; p = 0.002), while age and comorbidity were not found to be statistically associated with length of stay. Higher AGD score remained significantly associated with longer length of stay on multivariable analysis (0.93 day increase per unit increase in AGD; 95% CI 0.15–1.71; p = 0.019). AGD was the only metric associated with increased risk of ICU admission (6.6 vs 5.0 geriatric deficits for those admitted vs not admitted to ICU; p = 0.024). Conclusions Frailty is associated with increased length of hospital stay and ICU admission in older adults with HNC undergoing surgery. GA can be used to counsel patients on the expected postoperative course.

PURPOSE This study determined whether an electronic version of the geriatric assessment is feasible in a multi-institutional, diverse setting. METHODs Ten sites within the Alliance for Clinical Trials in Oncology participated. Patients who had active cancer or a history of cancer and were 65 years of age or older were eligible. The geriatric assessment was completed with an electronic data capture system that had been loaded onto iPads. Feasibility was defined a priori as completion in at least 70% of patients either with or without help. To enhance racial diversity, the original sample size was later changed and augmented by 50% with the intention of increasing enrollment of older minority patients. RESULTS A total of one hundred fifty-four patients were registered with a median age of 72 years (range, 65-91 years). Forty-three (28%) identified themselves as African American or Black. One hundred forty-one patients (92%) completed the electronic geriatric assessment. Feasibility was observed across all subgroups, regardless of race, education, performance status, comorbidities, and cognition; 124 patients (81%) completed the geriatric assessment without help. Reasons for not completing the geriatric assessment are as follows: clinic visit did not occur (n = 6), no iPad connection to the Internet (n = 3), patient declined (n = 2), prolonged hospitalization (n = 1), and patient died (n = 1). Reasons for needing help, as reported by study personnel, were as follows: the patient preferred that research personnel ask the questions (n = 9), vision problem (n = 3), lack of comfort with the iPad (n = 2), questions were not clear (n = 1), less proficient in English (n = 1), and challenge in pressing the green button to go to the next question (n = 1). CONCLUSION The electronic geriatric assessment is feasible in a multi-institutional setting that includes a notable proportion of African American or Black patients.

Rapid expansion of telemedicine is one of the transformative healthcare consequences of the COVID pandemic. As a result, telemedicine has allowed clinicians to address the needs of older adults with cancer, who faced the highest risks from COVID, while maintaining safety at home. In light of the COVID experience, which is an important source of learning, this article provides guidance on approaches to enhance telemedicine-enabled supportive care for the geriatric cancer patient.

Purpose Research on the impact of various intraoperative haemodynamic variables on the incidence of postoperative ICU admission among older patients with cancer is limited. In this study, the relationship between intraoperative haemodynamic status and postoperative intensive care unit admission among older patients with cancer is explored. Methods Patients aged ≥75 who underwent elective oncologic surgery lasting ≥120min were analysed. Chi-squared and t-tests were used to assess the associations between intraoperative variables with postoperative intensive care unit admission. Multivariable regressions were used to analyse potential predict risk factors for postoperative intensive care unit admission. Results Out of 994 patients, 48 (4.8%) were admitted to the intensive care unit within 30 days following surgery. Intensive care unit admission was associated with the presence of ≥4 comorbid conditions, intraoperative blood loss ≥100mL, and intraoperative tachycardia and hypertensive urgency. On multivariable analysis, operation time ≥240min (Odds Ratio [OR] = 2.29, p = 0.01), and each minute spent with intraoperative hypertensive urgency (OR = 1.06, p = 0.01) or tachycardia (OR = 1.01, p = 0.002) were associated with postoperative intensive care unit admission. Conclusion Intraoperative hypertensive urgency and tachycardia were associated with postoperative intensive care unit admission in older patients undergoing cancer surgery.

Sentinel lymph node biopsy (SLNB) is often omitted in selected patients with advanced primary melanoma, although the justification/criteria for omission have been debated. We sought to determine whether assessment of frailty could serve as an objective marker to guide selection for SLNB in patients with advanced primary melanoma. Patients presenting with clinical stage IIC (ulcerated, > 4 mm Breslow thickness) cutaneous melanoma from January 1999 through June 2019 were included. Frailty was assessed using the Memorial Sloan Kettering Frailty Index (MSK FI), a composite score of functional status and medical comorbidities. Five-year melanoma-specific survival (MSS) and overall survival (OS) were estimated using Cox regression, and predictors of OS were identified using competing risk models. MSS did not differ between patients who did (n = 451) or did not undergo SLNB (n = 179) [63.2% vs. 65.0%, p = 0.14]; however, omission of SLNB was associated with decreased 5-year OS (29% vs. 44%, p

OBJECTIVES: To determine whether the Memorial Sloan Kettering Frailty Index (MSK-FI) is associated with decision-making in older women surgically treated for advanced-stage ovarian cancer. METHODS: We retrospectively applied the MSK-FI to women ≥70 years with newly diagnosed advanced-stage ovarian cancer surgically treated at our institution from 01/2001–05/2017. MSK-FI components, including 10 comorbidities and functional assessment, were extracted from medical records. The MSK-FI ranges from 0–11, with higher scores indicating greater frailty. The primary outcome was the association between frailty and rate of primary debulking surgery (PDS), for which a multivariable logistic regression was used, adjusted for stage and histology. RESULTS: We identified 430 women treated with PDS (n=231, 54%) or neoadjuvant chemotherapy/interval debulking (n=199, 46%) with complete data. MSK-FI score distribution was: “0”, 95 patients (22%); “1”, 172 (40%); “2”, 89 (21%); and “3+”, 74 (17%). More-frail patients were less likely to have undergone PDS (OR for a unit increase of MSK-FI: 0.64; 95%CI, 0.53–0.77; p

Objectives: Care for older adults with cancer became more challenging during the COVID-19 pandemic. We sought to examine cancer care providers' attitudes toward the barriers and facilitators related to the care for these patients during the pandemic. Materials and Methods: Members of the Advocacy Committee of the Cancer and Aging Research Group, along with the Association of Community Cancer Centers, developed the survey distributed to multidisciplinary healthcare providers responsible for the direct care of patients with cancer. Participants were recruited by email sent through four professional organizations' listservs, email blasts, and messages through social media. Results: Complete data was available from 274 respondents. Only 15.4% had access to written guidelines that specifically address the management of older adults with cancer during the COVID-19 pandemic. Age was ranked fifth as the reason for postponing treatment following comorbid conditions, cancer stage, frailty, and performance status. Barriers to the transition to telehealth were found at the patient-, healthcare worker-, and institutional-levels. Providers reported increased barriers in accessing basic needs among older adults with cancer. Most respondents agreed (86.3%) that decision making about Do Not Resuscitate orders should be the result of discussion with the patient and the healthcare proxy in all situations. The top five concerns reported were related to patient safety, treatment delays, healthcare worker mental health and burnout, and personal safety for family and self. Conclusion: These findings demand resources and support allocation for older adults with cancer and healthcare providers during the COVID-19 pandemic.

PURPOSE: Frailty is associated with adverse outcomes following radical cystectomy. Prospective tools to identify factors affecting outcomes are needed. We describe a novel electronic rapid fitness assessment to evaluate geriatric patients undergoing radical cystectomy. MATERIALS AND METHODS: Prior to undergoing radical cystectomy between February 2015 and February 2018, 80 patients over the age of 75 completed the electronic rapid fitness assessment and were perioperatively comanaged by the Geriatrics Service. Physical and cognitive function over 12 domains were evaluated and an accumulated geriatric deficit score compiled. Hospital length of stay, discharge disposition, unplanned intensive care unit admissions, urgent care visits, readmissions, complications, and deaths were assessed. RESULTS: Sixty-five patients who underwent radical cystectomy for bladder cancer without concomitant procedures completed the assessment. Median age was 80 (77, 84), and 52 (80%) were male. A higher proportion of patients with intensive care unit admission, urgent care visit, and major complications had impairments identified within electronic rapid fitness assessment domains, including Timed Up and Go. Readmission rates were similar between patients with or without deficits identified. Higher accumulated geriatric deficit score was significantly associated with intensive care unit admission (p=0.035), death within 90 days (p=0.037), and discharge to other than home (p=0.0002). CONCLUSIONS: We demonstrated the feasibility of assessing fitness in patients over 75 undergoing radical cystectomy using a novel electronic fitness tool. Physical limitations and overall impairment corresponded to higher intensive care unit admission rates and adverse postoperative outcomes. Larger studies in less resourced environments are required to validate these findings.

The incidence of most cancers increase with increasing age. Cancer is the second most common cause of death in older adults after cardiovascular disease. Many common cancers in older adults can be prevented from occurring or can be identified at an early stage and be effectively treated. Though cancer is feared primarily because of premature mortality, for many older adults, preventing and identifying cancer in its early stages, in an attempt to reduce discomfort and disability associated with advanced cancer and cancer treatment, is also a priority. Overscreening for cancer in older adults, can lead to unnecessary diagnostic testing and unnecessary treatment. Both older adults and their healthcare providers need guidance on the appropriate use of cancer prevention and screening interventions. This is Part 2 of a two part clinical review on cancer prevention and screening for adults, 65 years of age and older. Guidance is provided regarding the prevention and early identification of breast, prostate, cervical, ovarian and endometrial cancer. The prevention of lung, colorectal, bladder and kidney cancer were addressed in Part 1.

The number of older adults with cancer is increasing. Over the past 3 decades, geriatric oncology research has focused on improving the assessment of frailty and fitness of older adults with cancer as well as methods of improving their outcomes. At the same time, advances in digital health technologies have opened new frontiers for reaching this goal. Digital health technologies encompass a variety of solutions, from electronic patient-reported outcomes (ePROs) to big data and wireless sensors. These solutions have the potential to further advance our understanding of patients’ experiences during cancer treatment. Whereas the data on the feasibility and utility of such solutions in the care of older adults with cancer are limited, interest from digital health oncology researchers to further explore the benefits of these products is increasing. In this article, we describe the focus of geriatric oncology, the rationale behind the need to explore digital health technologies in this setting, and emerging data and ongoing studies, as well as provide guidelines for proper selection, implementation, and testing of digital health solutions in the context of geriatric oncology.

Objectives The goal of this study was to evaluate the relationship between social support (SS) and grade 3–5 chemotherapy-related toxicities among older adults with cancer. Methods This is a secondary analysis of a prospective longitudinal study of patients aged 65+ with solid cancer which led to the development of a predictive model for grade 3–5 chemotherapy-related toxicity (the Cancer and Aging Research Group [CARG] Chemotherapy Toxicity Risk Score). SS was measured by a modified version of Medical-Outcome Study-Social Support Survey and grade 3–5 hematological and non-hematological toxicities were captured and graded using CTCAE version 3.0. Patients were categorized into those with poor (SS score ≤ 75) and good SS (score of 76–100). Multivariate polychotomous logistic regression was used to examine the associations between SS and chemotherapy-related toxicity with adjustment for the CARG Toxicity Risk Score. Results Compared to patients with good SS, those with poor SS were less likely to have grade 3–5 toxicity, especially for non-hematological toxicity (adjusted OR = 0.52, p = .02). Patients who did not have someone to take them to the doctor “most” or “all of the time” were less likely to have grade 3–5 non-hematological toxicity compared to patients who had someone to take them to the doctor most or all of the time (adjusted OR = 0.32, p = .02). Conclusion Our study showed that patients with poor SS, especially those with less availability of someone to take them to doctors were less likely to have a documented grade 3–5 non-hematological toxicity.

Introduction Geriatric medical comanagement of older surgical patients with cancer is associated with lower 90-day postoperative mortality. Here, we investigate the hypothesis that this association varies on the basis of the degree of a patient's frailty. Methods Frailty was assessed using the Memorial Sloan Kettering Frailty Index. Our hypothesis was evaluated using two approaches, both adjusted for age, sex, American Society of Anesthesiologists Physical Status, preoperative albumin, operating room duration, and estimated blood loss. A logistic regression was performed with 90-day mortality as the outcome and geriatric comanagement, continuous Memorial Sloan Kettering Frailty Index, and an interaction term between these two variables as the primary predictors. We then categorized frailty into four levels and, within each level, performed logistic regression with geriatric comanagement as the primary predictor and 90-day mortality as the outcome. Finally, we extracted the effect size and used a meta-analytic approach to test for heterogeneity. Results Of 1687 patients aged ≥75 years who underwent elective cancer surgery with a length of stay of ≥1 day, 931 (55%) received comanagement; 31 patients (3.3%) who received comanagement died within 90 days, compared with 72 (9.5%) who did not. Ninety-day mortality was not statistically significantly different by degree of frailty in either analysis (interaction P = 0.4; test of heterogeneity P = 0.8). Conclusion Geriatric comanagement is valuable for all older surgical patients, not just the frail, and should be provided to as large a portion of the older surgical population as possible. Further research should examine predictors of response to geriatric comanagement.

Older patients are at increased risk for complications and death following allogeneic hematopoietic cell transplantation (allo-HCT). Traditional transplant-specific prognostic indices such as hematopoietic cell transplant comorbidity index (HCT-CI) may not capture all underlying geriatric vulnerabilities, and in-depth evaluation by a geriatrician prior to transplant may not always be available. We hypothesize that routine pre-transplant interdisciplinary clinical assessment may uncover prognostically important geriatric deficits. Using an institutional database of 457 adults aged 60 years and older who underwent first allo-HCT for hematological malignancies from 2010 to 2017, we examined the prognostic impact of pre-transplant deficits in geriatric domains of function, mobility, mood, medication, nutrition, and relevant biochemical markers. We found that impairment in instrumental activities of daily living (IADL) was associated with reduced survival through increased non-relapse mortality (NRM, HR = 1.82; 95% CI, 1.04-3.19). The combination of IADL impairment with either HCT-CI/age index or disease risk index readily stratified NRM and overall survival, respectively. In addition, we found that even mild renal dysfunction adversely impacted survival in older transplant patients. Our findings establish important geriatric vulnerabilities in older patients prior to allo-HCT and may provide an entry point for prospective, interventional trials to improve their outcomes.

Objectives Care for older adults with cancer became more challenging during the COVID-19 pandemic. We sought to examine healthcare providers' clinical barriers, patient questions, and overall experiences related to care delivery for these patients during the pandemic. Materials and methods Members of the Advocacy Committee of the Cancer and Aging Research Group along with the Association of Community Cancer Centers developed a 20-question survey for healthcare providers of older adults with cancer. Eligible participants were recruited by email sent through professional organizations' listservs, email blasts, and social media. This manuscript reports the qualitative data from the survey's three open-ended questions. Free text, open-ended survey items were analyzed by two independent coders for identification of common themes using NVivo software. Theme agreement was reached through consensus and count comparisons of participant responses were made. Results Healthcare system organizational challenges and meeting basic needs and support were commonly reported themes among respondents (n = 274). Barriers to care delivery included organizational challenges, patients' access to resources and support, concerns for patients' mental and physical health, and telehealth challenges. Respondents reported older adults were asking about their health and cancer care as well as access to basic needs and supports. Providers described worrying about patients' mental health, fear of personal safety, frustration in multi-level institutions, as well as experiencing positive leadership and communication. Conclusion Providers are faced with balancing their concerns for personal and patient safety. These findings demand resources and support allocation for older adults with cancer and healthcare providers during the COVID-19 pandemic.

Key Points Question Is collaboration between geriatricians and surgeons in the perioperative care of older patients with cancer associated with postoperative outcomes? Findings In this cohort study including 1892 patients aged 75 years and older, the adjusted probability of death within 90 days after surgery was 4.3% for patients who received geriatric comanagement of care, compared with 8.9% for patients who received care management from the surgical service only. Meaning These findings suggest that when feasible, older patients undergoing surgical treatment for cancer should receive geriatric care comanagement as part of their perioperative care., This cohort study examines outcomes associated with geriatric comanaged perioperative care vs care managed by the surgery team alone among patients aged 75 years and older with cancer., Importance Collaboration between geriatricians and surgeons in the perioperative treatment of older patients has been associated with improved outcomes in several nononcologic specialties. Similar associations may be possible among older patients with cancer. Objective To investigate the associations of geriatric comanagement of care for older patients undergoing cancer-related surgical treatment with 90-day postoperative mortality, rate of adverse surgical events, and postoperative use of inpatient supportive care services. Design, Setting, and Participants This retrospective cohort study assessed outcomes of patients who received geriatric comanaged care vs those who did not using multivariable logistic regression analysis, with 90-day mortality as the outcome and geriatric comanagement of care as the main variable, with adjustment for age, sex, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index score, preoperative albumin level, operative time, and estimated blood loss. A similar model was used to assess the association of geriatric comanagement with adverse surgical events, defined as any major complication, readmission, or emergency department visit within 30 days. Patients aged 75 years and older who underwent an elective surgical procedure with a hospital stay of at least 1 day at a single tertiary-care cancer center between February 2015 and February 2018 were included. Data were analyzed from January to July 2019. Exposures Postoperative care comanaged by the geriatrics service and surgical service (geriatric comanagement group) vs by the surgical service only (surgical service group). Main Outcomes and Measures 90-day mortality, adverse surgical events, and use of supportive care services. Results Of 1892 patients included, 1020 (53.9%) received geriatric comanagement of care; these patients, compared with those who received care managed by the surgery service only, were older (mean [SD] age, 81 [4] years vs 80 [4] years; P

Background The number of older patients with gastrointestinal cancer is increasing due to an aging global population. Minimizing reliance on an in-clinic patient performance status test to determine a patient’s prognosis and course of treatment can improve resource utilization. Further, current performance status measurements cannot capture patients' constant changes. These measurements also rely on self-reports, which are subjective and subject to bias. Real-time monitoring of patients' activities may allow for a more accurate assessment of patients’ performance status while minimizing resource utilization. Objective This study investigates the validity of consumer-based activity trackers for monitoring the performance status of patients with gastrointestinal cancer. Methods A total of 27 consenting patients (63% male, median age 58 years) wore a consumer-based activity tracker 7 days before chemotherapy and 14 days after receiving their first treatment. The provider assessed patients using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale and Memorial Symptom Assessment Scale-Short Form (MSAS-SF) before and after chemotherapy visits. The statistical correlations between ECOG-PS and MSAS-SF scores and patients’ daily step counts were assessed. Results The daily step counts yielded the highest correlation with the patients' ECOG-PS scores after chemotherapy (P Conclusions This study demonstrates the feasibility of using inexpensive, consumer-based activity trackers for the remote monitoring of performance status in the gastrointestinal cancer population. The findings need to be validated in a larger population for generalizability.

Multifactorial geriatric syndromes are highly prevalent in older patients with cancer. Because an increasing number of older patients undergo allogeneic hematopoietic stem cell transplantation (allo-HCT), we examined the incidence and impact of transplant-related geriatric syndromes using our institutional database and electronic medical records. We identified 527 patients age 60 years or older who had undergone first allo-HCT from 2001 to 2016 for hematologic malignancies. From the initiation of conditioning to 100 days posttransplant, new geriatric syndromes were predominantly delirium with a cumulative incidence of 21% (95% confidence interval [CI], 18%-25%) at day 100 followed by fall at 7% (95% CI, 5%-9%). In multivariable analyses of available pretransplant variables, fall within the last year, potentially inappropriate use of medication, thrombocytopenia, and reduced creatinine clearance were significantly associated with delirium; age older than 70 years and impaired activities of daily living were significantly associated with fall. In the 100-day landmark analysis, both delirium (hazard ratio [HR], 1.66; 95% CI, 1.09-2.52; P = .023) and fall (HR, 2.14; 95% CI, 1.16-3.95; P = .026) were significantly associated with increased nonrelapse mortality; moreover, fall (HR, 1.93; 95% CI, 1.18-3.14; P = .016), but not delirium, was significantly associated with reduced overall survival. Here, we establish baseline incidences and risk factors of common transplant-related geriatric syndromes. Importantly, we demonstrate significant associations of delirium and fall with inferior transplant outcomes. The burden and impact of transplant-related geriatric syndromes warrant the institution of patient-centered, preemptive, longitudinal, and multidisciplinary interventions to improve outcomes for older allo-HCT patients.

INTRODUCTION: Prognostic Nutritional Index (PNI) is associated with disease and overall survival in patients with cancer. We aimed to assess the relationship between PNI, frailty, and six-month postoperative survival in older patients with cancer. METHODS: In this retrospective study, patients with cancer aged ≥75 who underwent geriatric preoperative evaluation and then proceeded with elective surgery with hospital length of stay of ≥1 day and had six-month follow-up were included. PNI is measured by preoperative [10 × albumin(gr/dl)]+[0.005 × absolute lymphocyte count (per mm(3))]. Higher PNI is suggestive of better nutritional status. Frailty was assessed by geriatric assessment. PNI among patients with and without each age-related impairment was evaluated. Pearson correlation coefficient was used to assess the correlation between the number of age-related impairments and PNI. Multivariable regression analysis was used to assess the relationship between six-month mortality and PNI. RESULTS: PNI ranged from 19–49 (average 40) among 1,025 patients (average age 80). Patients with impairment in Karnofsky Performance Status, falls in the past year, prolonged timed up and go test, limited social activity, significant weight loss, polypharmacy, polycomorbid conditions, depression, and dependent for basic and instrumental activities of daily living had lower PNI than fit patients. The correlation coefficient between PNI and number of aging impairments was −0.28 (p

Importance Many patients with metastatic cancer receive high-cost, low-value care near the end of life. Identifying patients with a high likelihood of receiving low-value care is an important step to improve appropriate end-of-life care. Objective To analyze patterns of care and interventions during terminal hospitalizations and examine whether care management is associated with sociodemographic status among adult patients with metastatic cancer at the end of life. Design, Setting, and Participants This retrospective, population-based cross-sectional study used data from the Healthcare Cost and Utilization Project to analyze all-payer, encounter-level information from multiple inpatient centers in the US. All utilization and hospital charge records from national inpatient sample data sets between January 1, 2010, and December 31, 2017 (n = 58 761 097), were screened. The final cohort included 21 335 patients 18 years and older at inpatient admission who had a principal diagnosis of metastatic cancer and died during hospitalization. Data for the current study were analyzed from January 1, 2010, to December 31, 2017. Exposures Patient demographic characteristics, patient insurance status, hospital location, and hospital teaching status. Main Outcomes and Measures Receipt of systemic therapy (including chemotherapy and immunotherapy), receipt of invasive mechanical ventilation, emergency department (ED) admission, time from hospital admission to death, and total charges during a terminal hospitalization. Results Among 21 335 patients with metastatic cancer who had terminal hospitalizations between 2010 and 2017, the median age was 65 years (interquartile range, 56-75 years); 54.0% of patients were female; 0.5% were American Indian, 3.3% were Asian or Pacific Islander, 14.1% were Black, 7.5% were Hispanic, 65.9% were White, and 3.1% were identified as other; 58.2% were insured by Medicare or Medicaid, and 33.2% were privately insured. Overall, 63.2% of patients were admitted from the ED, 4.6% received systemic therapy, and 19.2% received invasive mechanical ventilation during hospitalization. Racial and ethnic minority patients had a higher likelihood of being admitted from the ED (Asian or Pacific Islander patients: odds ratio [OR], 1.43 [95% CI, 1.20-1.72]; P

Introduction/Methods The trajectory of functional decline and the prevalence of geriatric syndromes have not been examined among long-term survivors of older allo-HCT recipients. We previously described significant burden and adverse impact of post-transplant geriatric syndromes, delirium and fall, among older allogeneic recipients. We report here theprevalence and impact of geriatric syndromes in 2-year, progression-free survivors among this cohort of patients using our institutional database. Baseline characteristics, transplant outcomes, geriatric assessment domains, and geriatric syndromes were obtained and analyzed as previously described. Results We identified 199 2-year, progression-free survivors of patients allografted at age ≥60 years from 2001 to 2016, including 111 out of 241 patients on the CD34+ selection platform (46%), and 88 out of 231 T-cell replete patients (38%). The median age at allo-HCT was 65.4 years (range 60 – 78.7); 73% had myeloid malignancies; 69% had high/very high risk HCT-CI/age; 14% had a mismatched donor; and 56% had a CD34+ selected graft. With a median follow-up of 5.7 years for survivors, the 3-yr OS and RFS from the 2-year landmark was 86% (95% CI, 80 – 91) and 83% (95% CI, 78 – 89). Thirty-three patients died, including 8 from relapse/disease progression, and 25 from non-relapse mortality (6 each from secondary neoplasm, organ failure, and infections). The 3-year cumulative incidence of new functional impairment (FI), defined as new admission to skilled nursing facility, fall, or assisted walking device from the 2-year landmark, was 20% (95% CI, 15 – 27). In addition, the 3-year cumulative incidence of new psychiatric illness and cognitive decline was 6% (95% CI, 3 – 11) and 5% (95% CI, 3 – 10), respectively (Figure 1). We examined factors associated with new FI and found that, among others, patients who were transplanted with a CD34+ selected graft had lower incidence of new FI in univariate (hazard ratio [HR]=0.49, 95% CI 0.28 – 0.86, P=0.014) and multivariate analysis with borderline significance (HR=0.53, 95% CI 0.27 – 1.02, P=0.056). In 2-year landmark analyses, both high/very high HCT-CI/age index and mismatched donor were significantly associated with inferior OS and RFS (Table 1). Conclusion While limited by the single institution, retrospective design, heterogenous transplant approach, and likely under-reporting, our findings nevertheless illustrate the high prevalence of FI among older allo-HCT survivors, which maybe attenuated by the CD34+ selection platform. In addition, the impact of graft-versus-host disease on the development of geriatric syndromes merits closer examination. While requiring prospective confirmation, long-term functional impairment should be considered as an important secondary outcome when comparing curative strategies to other less intense approaches in older patients with hematologic malignancies.

Purpose Inspired by the American Society of Clinical Oncology's recommendations to strengthen the evidence base for older adults with cancer, the purpose of this systematic review is to identify the reporting of treatment efficacy and adverse events specific to older adults with cancer in Phase III chemo-therapeutic clinical trials. This review also investigates the frequency with which these data points were reported in the literature to identify gaps in reporting and opportunities to expand the knowledge base on clinical outcomes for older adults with cancer. Methods Chemo-therapeutic clinical trial data published from July 1, 2016 to June 30, 2017 was reviewed. Manuscripts (n = 929) were identified based on keyword searches of EMBASE and PubMed. After removal of duplicates (n = 116) and articles that did not meet this study's inclusion criteria (n = 654), 159 articles were identified for review. Results Reviewed papers were published in 36 different scientific journals and included twenty-five different cancer types. Of the 159 articles, 117 (73.6%) reported age-specific medians and 75 (47.2%) included stratifications of data by age. Treatment efficacy was reported in 96.2% of the articles with 39.9% reporting effectiveness of treatment by age. Reporting of adverse events was included in 84.9% of the articles with only 8.9% reporting these events stratified by age. Conclusion Results suggest inadequate reporting of treatment efficacy and adverse events as well as basic descriptive statistics about the age distribution of study subjects. Conscious efforts are needed to address these deficiencies at every level of planning and conducting clinical trials as wells as reporting outcomes stratified by age. Ultimately, standardized reporting could lead to improved treatment decisions and outcomes for older adults with cancer.

Geriatric assessment (GA) is used in oncology to identify deficits in older patients with cancer that may affect treatment choice. We examine GA in 550 patients with early breast cancer, including both younger (

For years, surgeons have explored the relationship between age and surgical outcomes. Over time, it is more widely accepted that frailty and fitness of older patients, rather than their age, should be considered in surgical decision making. The gold standard of frailty assessment is comprehensive geriatric assessment (CGA) which is best performed by geriatricians. In the past decade, Digital Health Technologies that range from electronic solutions for electronic Patient-reported Outcomes to wearables and sensors have emerged. As these solutions are likely to expand and advance in the next years, we will review the history of investigating factors, especially aging-related factors associated with surgical outcomes, and the current supportive data about the potential and challenges of Digital Health Technologies in complementing or replacing some of the components of CGA by 2025.

Background:The American Society of Anesthesiologists physical status (ASA PS) classification system is the most common method of assessing preoperative functional status. Comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool for preoperative assessment of older adults. The goal of this study was to assess the correlation between ASA classification and CGA deficits among oncogeriatric patients and to determine the association of each with 6-month survival.Patients and Methods:Oncogeriatric patients (aged ≥75 years) who underwent preoperative CGA in an outpatient geriatric clinic at a single tertiary comprehensive cancer center were identified. All patients underwent surgery, with a hospital length of stay (LOS) ≥1 day and at least 6 months of follow-up. ASA classifications were obtained from preoperative anesthesiology notes. Preoperative CGA scores ranged from 0 to 13. Six-month survival was assessed using the Social Security Death Index.Results:In total, 81 of the 980 patients (8.3%) included in the study cohort died within 6 months of surgery. Most patients were classified as ASA PS III (85.4%). The mean number of CGA deficits for patients with PS II was 4.03, PS III was 5.15, and PS IV was 6.95 (PP=.01), 30-day ICU admissions (OR, 2.77;P=.003), hospital LOS (OR, 1.03;P=.02), and preoperative albumin level (OR, 0.36;P=.004). ASA classification was not associated with 6-month mortality.Conclusions:Number of CGA deficits was strongly associated with 6-month mortality; ASA classification was not. Preoperative CGA elicits critical information that can be used to enhance the prediction of postoperative outcomes among older patients with cancer.

BACKGROUND Surgery is a notable stressor for older adults with cancer, who often are medically and psychosocially complex. The current study examined rates of preoperative psychosocial risk factors in older adults with cancer who were undergoing elective surgery and the relationship between these risk factors and the provision of mental health services during the postoperative hospitalization. METHODS A total of 1211 patients aged ≥75 years who were referred to the geriatrics service at a comprehensive cancer center were enrolled. Patients underwent elective surgery with a length of stay of ≥3 days and were followed for at least 30 days after surgery. A comprehensive geriatric assessment was administered as part of routine preoperative care. Bivariate relationships between demographic and surgical characteristics and the preoperative comprehensive geriatric assessment and the receipt of mental health services during the postoperative hospitalization period were examined. Characteristics with bivariate relationships that were significant at the level of P

Objective To assess fitness and outcomes in older women undergoing cytoreductive surgery for advanced ovarian cancer (OC). Methods A prospective study of OC patients referred to Geriatrics Clinic for preoperative evaluation. All completed the electronic Rapid Fitness Assessment (eRFA) and were followed by Geriatrics Service during inpatient postoperative course, co-managed by Surgical Service. Outcomes were 30-day Intensive Care Unit (ICU) admission, emergency room (ER) visit, readmission, mortality, adverse surgical events. Descriptive statistics were used. Results Forty-two women (median age 79, range 74–88), 38 with newly diagnosed advanced OC, 4 with recurrent OC, underwent cytoreductive surgery between 5/2015 and 1/2018. Preoperative age-related impairments per eRFA: high level of distress (71%), functional dependency (59%), limited social activity (59%), depression (57%), slow Time Up and Go (54%), Karnofsky Performance Score (KPS) ≤ 80 (41%), poor social support (43%), polypharmacy (35%), weight loss>10 lbs. (25%), fall history (244%), cognitive impairment (13%). Median number of comorbid conditions = 3. Among 38 newly diagnosed women, 26 (68%) had stage IIIC, 11 (29%) stage IV. Sixteen (42%) underwent primary debulking surgery, 22 (58%) neoadjuvant chemotherapy followed by interval debulking surgery. Median duration of surgery = 245.5 min (range 95–621); median hospital length of stay = 6 days (range 0–22). Optimal debulking rate = 97%, complete gross resection rate = 63%. One patient was admitted to ICU, 26% had 30-day ER visit, 10% were readmitted. Any complication, minor complication, major complication occurred in 58%, 55%, 8%, respectively. Median time from surgery to postoperative chemotherapy = 34.5 days (range 19–66). Median follow-up = 15.7 months (range 3.7–38.0), 12-month survival = 93.3%. There was no 180-day mortality. Conclusion Cytoreductive surgery among older women with advanced OC and frailty can be performed safely in a tertiary care center with preoperative/postoperative geriatric and surgical co-management.

12008 Background: Many patients with metastatic cancer receive high-cost, low-value care near the end of life. We examined interventions during terminal hospitalizations for patients with metastatic cancer to identify those with high likelihood of receiving futile care. Methods: A retrospective population-based cohort analysis of encounter-level data from the National Inpatient Sample was conducted, including records from 2010-2017 for patients ages ≥18 with metastatic cancer who died during hospitalization. We fit multivariable binomial logistic regression models to examine associations between exposures, including patient demographics, and the main outcome of aggressive, low-value, and high-cost medical care (Table). Results: Out of 321,898 hospitalizations among patients with metastatic cancer, 21,335 (6.6%) were terminal. Of these, 65.9% were white, 14.1% Black, 7.5% Hispanic, 58.2% were insured by Medicare or Medicaid, and 33.2% were privately insured. Overall, 63.2% were admitted from the Emergency Department (ED), 4.6% received systemic therapy, and 19.2% received invasive ventilation. Median total charges were $43,681. Black patients and publicly insured patients had higher likelihoods of admission from the ED and receiving ventilation, as well as higher total charges; similar trends emerged among patients of Asian race and Hispanic ethnicity. Patients hospitalized at urban teaching hospitals had higher likelihoods of receiving systemic therapy, ventilation, and incurring higher total charges (Table). Conclusions: Metastatic cancer patients of racial and ethnic minority groups and those with Medicare or Medicaid were more likely to receive low-value, aggressive interventions at the end of life. Further studies are needed to determine the underlying causes of these disparities in order to implement prospective interventions and advance appropriate end-of-life care.[Table: see text]

e18606 Background: Understanding factors associated with poor surgical outcomes of older adults with cancer is necessary in identifying high risk patients and finding ways to mitigate poor outcomes following surgery. In this study, we evaluated whether frailty is associated with intensive postoperative healthcare utilization for this vulnerable population. Methods: This was a single hospital, retrospective cohort study, using the Memorial Sloan Kettering Frailty Index (MSK-FI) to define frailty, with higher MSK-FI corresponding to increased frailty. Multivariable logistic regression with random intercept models were used to assess the association between frailty and 30-day postoperative Intensive Care Unit (ICU) admission, and Specialized Advanced Care Unit (SACU) admission, separately. Covariates included surgical department, age, sex, surgical stress score, preoperative albumin level, and whether patients took a Beers criteria medication prior to surgery. Results: We identified 4417 patients over the age of 65 undergoing elective surgery between January 2015 and December 2018 at our institution and had a length of stay of at least one day. A quarter of patients had an MSK-FI score of 3 or greater. Among our patients, 3.8% (95% CI 3.2%, 4.4%), and 5.4% (95% CI 4.8%, 6.1%) were admitted to the ICU, and the SACU, respectively. We found evidence of an association between greater frailty and increased risk of ICU admission (OR per one-point increase in MSK-FI 1.44; 95% CI 1.31, 1.59; p-value < 0.001), and SACU admission (OR per one point increase in MSK-FI 1.46; 95% CI 1.33, 1.60; p-value < 0.001). For example, for a patient with an MSK-FI score of 2, the predicted risk of ICU admission is 2.2% and SACU admission is 1.1%, compared to 4.5% and 2.2%, respectively, for a patient with an MSK-FI score of 4, when all continuous covariates are set to the mean and the categorical covariates are set to the mode. Conclusions: Frailty based on the MSK-FI is associated with intensive postoperative care utilization in this population of older adults with cancer. Future studies should assess the impact of this information on surgery decision making for this vulnerable population.

e24016 Background: It is unclear whether older adults undergoing head and neck cancer (HNC) surgery have significant functional and mental health impairments perioperatively. We examined postoperative physical, nutritional and psychosocial service use among a cohort of older adults with HNC co-managed by geriatricians and surgeons. Methods: Our sample consisted of older adults who were referred to the Geriatrics Service at MSKCC between 2015-2019 and took a geriatric assessment (GA) prior to undergoing HNC surgery. Physical, nutritional and psychosocial service utilization during the patient’s stay was assessed. Physical services included a physical, occupational or rehabilitation consult. Nutritional services consisted of speech and swallow or nutritional consult. Psychosocial services consisted of a psychiatry, psychology, or social work consult. All patients were comanaged by geriatricians and surgeons. Relationships between each service use, all 12 geriatric deficits, demographic, and surgical characteristics were assessed using chi-squared analysis and t-test for continuous variables. Results: 159 patients (median age 81) were included. The median time in the OR was 342 min and the median length of stay (LOS) was 6 days. The most common GA impairments were major distress (61%), depression (59%), Social Activity Limitation (SAL) (53%) and deficits in Activities of Daily Living (ADL) (44%). Nutritional and physical services were used much more frequently than psychosocial services (79% and 85% vs 31%; p=.01 and p=.003, respectively). Lower ADL, increasing OR time and LOS were statistically associated with utilization of the three services and SAL was associated with a greater proportion of physical and psychosocial consults (Table). No demographic characteristics were associated with any of the services. Only 38% of patients with major distress and 40% of patients with depression had a mental health consult. In comparison, 93% of patients with an abnormal TUG had a physical consult and 92% of patients with weight loss greater than 10 pounds prior to surgery got a nutritional consult. Conclusions: Many older adults with head and neck cancer experience aging-related impairments. Physical impairments are more commonly addressed than psychosocial impairments. Future studies should aim to identify and overcome barriers to addressing psychosocial issues in HNC patients. [Table: see text]

As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient’s needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient’s preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.

Background: The American College of Surgeons and American Geriatrics Society recommend performing a geriatric assessment (GA) in the preoperative evaluation of older patients. To address this, we developed an electronic GA, the Electronic Rapid Fitness Assessment (eRFA). We reviewed the feasibility and clinical utility of the eRFA in the preoperative evaluation of geriatric patients. Methods: We performed a retrospective review of our experience using the eRFA in the preoperative assessment of geriatric patients. The rate and time to completion of the eRFA were recorded. The first 50 patients who completed the assessment were asked additional questions to assess their satisfaction. Descriptive statistics of patient-reported geriatric-related data were used for analysis. Results: In 2015, 636 older patients with cancer (median age, 80 years) completed the eRFA during preoperative evaluation. The median time to completion was 11 minutes (95% CI, 11-12 minutes). Only 13% of patients needed someone else to complete the assessment for them. Of the first 50 patients, 88% (95% CI, 75%-95%) responded that answering questions using the eRFA was easy. Geriatric syndromes were commonly identified through the performance of the GA: 16% of patients had a positive screening for cognitive impairment, 22% (95% CI, 19%-26%) needed a cane to ambulate, and 26% (95% CI, 23%-30%) had fallen at least once during the previous year. Conclusions: Implementation of the eRFA was feasible. The eRFA identified relevant geriatric syndromes in the preoperative setting that, if addressed, could lead to improved outcomes.

Background and objectives Older cancer patients are less likely to return home after surgery. Utilization of post acute skilled services in this setting is associated with increased mortality. Medicare payments for post acute care continue to grow. This study aims to identify factors associated with the utilization of post acute services at hospital discharge after abdominopelvic cancer surgery. Methods This is a retrospective analysis of older cancer patients (age>75) who presented to the Geriatrics clinic at Memorial Sloan Kettering Cancer Center for preoperative evaluation between October 2010 and December 2012. Sociodemographic features, pre-operative geriatric assessment, hospitalization characteristics and discharge disposition data were collected and analyzed. Results Out of 592 patients (age>75), 291 (49.2%) were discharged home without services and 301 (50.8%) were discharged home with skilled services or to a skilled nursing facility. Older age (OR 1.058, P =0.010), preoperative ADL dependency (OR 2.242, P =0.001), longer operation time (OR 1.004, P P =0.004) were independently associated with skilled care utilization. Conclusions Optimizing preoperative status, implementing delirium prevention protocols and streamlining the hospital stay may impact the discharge disposition, helping control healthcare costs and achieving a better outcome for the older surgical cancer patient.

Endometrial cancer is the most common gynecologic cancer, and with a median age of 62 at diagnosis, it affects a significant number of older women. With increasing age and obesity rates in the world’s population, there is an anticipated concomitant increase in older women with endometrial cancer. Older women are more likely to die of endometrial cancer compared with younger patients. Reasons for this include more aggressive tumor biology, less favorable clinicopathologic features, and more advanced disease. Other factors, however, such as reluctance to offer surgical treatment to the older patient and increased complications of treatment are likely to be important. Management of endometrial cancer requires multidisciplinary care (surgery, radiation therapy, and systemic therapy). For each treatment, the feasibility (related to technical aspect of the procedure/treatment), side effects and safety (related to older-patient factors), and the overall benefit as it pertains to older women with endometrial cancer should be assessed carefully with a multidisciplinary approach. Despite the importance of these issues, the data are limited to answer these issues with clarity. In this article, we will review each treatment modality for older women with endometrial cancer. We will introduce the components of comprehensive geriatric assessment and their practical implication for older women with cancer in general and older women with endometrial cancer specifically.

12036 Background: Patients with prolonged hospital stay following surgery are at higher risk of readmission, emergency room visits, and mortality. In our study, we assessed the relationship between Geriatric Comanagement (GERI-CO) and adverse outcomes among these patients. Methods: In a retrospective study, patients aged 75+ with cancer who had hospital length of stay longer than 75% of cohort (8 days or longer) postoperatively at Memorial Sloan Kettering Cancer Center from 2011-18 were studied. GERI-CO status was obtained from medical records. Differences in sociodemographic, frailty, surgery, and comorbid conditions between GERI-CO and non-GERI-CO patients were assessed. Frailty was assessed by Memorial Sloan Kettering Frailty Index, score 0 to 11, higher score reflective of more frailty. Composite adverse outcome is a composite score of 30-day readmission, or emergency room visit, or 90 day mortality. Multivariable regression analysis was used to assess the relationship between GERI-CO and postoperative adverse outcome. Results: In total 1118 patients (634, 56.7% in the GERI-CO) were included. Patients in GERI-CO were older (80.8 vs. 79.9), more likely to undergo 3+ hours of surgery (66% vs. 43%), have 100+ cc intraoperative blood loss (78% vs. 72%), and have liver disease (16% vs. 10%), but were less likely to have kidney disease (19% vs. 25%), cardiac disease (28% vs. 35%), myocardial infarction (8% vs. 12%), pulmonary disease (15% vs. 20%), ASA-PS 4+ (11% vs. 21%) compared to non-GERI-CO patients. Gender, Frailty and the rest of comorbid conditions, and average length of stay (15 days) did not differ between groups. GERI-CO patients were less likely to have 30-day hospital admission (11% vs. 18%), emergency room visit (14% vs. 22%), or 90 day mortality (6% vs. 15%), and composite adverse outcome (20% vs. 37%) compared to non-GERI-CO patients. In the multivariable analysis, after adjustment for age, frailty, ASA-PS, operation time, intraoperative blood loss, kidney, cardiac and pulmonary disease, patients in GERI-CO were less likely to have composite adverse outcome (OR = 0.57, p = 0.002). Conclusions: GERI-CO program for patients with prolonged length of stay following surgery is associated with reduced 30-day hospital readmission, emergency room use, and 90-day mortality.

12034 Background: At ASCO 2019, we showed that the Memorial Sloan Kettering (MSK) Geriatric Co-management (GERI-CO) program was associated with improvement in 90-day postoperative mortality rate. Now, we present factors associated with the use of such program. Methods: At MSK, patients aged 75+ can be referred for perioperative GERI-CO. We retrospectively reviewed the available data of patients aged 75+ who underwent surgery within two months of their initial visit with the surgeon (2011 to 2019). Patients that were referred for GERI-CO were compared with those who were not: sociodemographic, frailty, comorbid conditions, and surgery characteristics. Frailty level was determined using the MSK Frailty Index (score ranges from 0-11, higher scores suggest more frailty). Multivariable regression analysis was used to assess factors associated with the use of the GERI-CO Program. Results: In total 12,398 patients (4422, 35.7% GERI-CO) were included. Average time from surgical consult to geriatric visit was 9 days. Patients in the GERI-CO program were older (80.7 vs. 79.6), less likely to be non-Hispanic White (87% vs. 91%), have English as primary language (84% vs. 89%), and be fit (12% vs. 17% with MSK-FI 0). They were more likely to have stroke history (5% vs. 4%), have diabetes (DM) (25% vs.20%), hypertension (78% vs. 71%), and peripheral vascular disease (14% vs. 12%), but less likely to have cardiac disease (22% vs. 26%), myocardial infarction (MI) (7% vs. 10%), pulmonary disease (13% vs. 16%). Patients referred for GERI-CO were more likely to undergo 3+ hours surgeries (25% vs. 8%), with 100+ cc intraoperative blood loss (41% vs. 22%), and hospital length of stay (LOS) of 3+ days (42% vs. 19%). In multivariable analysis, being frail (OR = 1.3 and 1.6 for MSK-FI 1-2 and 3+), longer surgery (OR = 2.6 and 3.6 for operation time 1.5-3 and 3+ hours), longer LOS (OR = 1.3 and 1.5 for LOS 1-2 and 3+ days), older age (OR = 1.06), having DM (OR = 1.15) were associated with higher likelihood of GERI-CO while having history of cardiac disease (OR = 0.55), MI (OR = 0.84), pulmonary disease (OR = 0.69) were associated with less likelihood of referral for GERI-CO. Conclusions: Our result shows the unique characteristics of patients managed in the GERI-CO program. This has implications for both implementation of GERI-CO program in other institutions and assessing outcomes of these patients.

In this review, we describe state-of-the-art digital health solutions for geriatric oncology and explore the potential application of emerging remote health-monitoring technologies in the context of cancer care. We also discuss the benefits and motivations behind adopting technology for symptom monitoring of older adults with cancer. We provide an overview of common symptoms and of the digital solutions–designed remote symptom assessment. We describe state-of-the-art systems for this purpose and highlight the limitations and challenges for the full-scale adoption of such solutions in geriatric oncology. With rapid advances in Internet-of-things technologies, many remote assessment systems have been developed in recent years. Despite showing potential in several health care domains and reliable functionality, few of these solutions have been designed for or tested in older patients with cancer. As a result, the geriatric oncology community lacks a consensus understanding of a possible correlation between remote digital assessments and health-related outcomes. Although the recent development of digital health solutions has been shown to be reliable and effective in many health-related applications, there exists an unmet need for development of systems and clinical trials specifically designed for remote cancer management of older adults with cancer, including developing advanced remote technologies for cancer-related symptom assessment and psychological behavior monitoring at home and developing outcome-oriented study protocols for accurate evaluation of existing or emerging systems. We conclude that perhaps the clearest path to future large-scale use of remote digital health technologies in cancer research is designing and conducting collaborative studies involving computer scientists, oncologists, and patient advocates.

The majority of patients with cancer are older adults. A comprehensive geriatric assessment (CGA) will help the clinical team identify underlying medical and functional status issues that can affect cancer treatment delivery, cancer prognosis, and treatment tolerability. The CGA, as well as more abbreviated assessments and geriatric screening tools, can aid in the treatment decision-making process through improved individualized prediction of mortality, toxicity of cancer therapy, and postoperative complications and can also help clinicians develop an integrated care plan for the older adult with cancer. In this article, we will review the latest evidence with regard to the use of CGA in oncology. In addition, we will describe the benefits of conducting a CGA and the types of interventions that can be taken by the interprofessional team to improve the treatment outcomes and well-being of older adults.

PURPOSE: Gait speed in older patients with cancer is associated with mortality risk. One approach to assess gait speed is with the ‘Timed Up and Go’ (TUG) test. We utilized machine learning algorithms to automatically predict the results of the TUG tests and its association with survival, using patient-generated responses. METHODS: A decision tree classifier was trained based on functional status data, obtained from preoperative geriatric assessment, and TUG test performance of older patients with cancer. The functional status data were used as input features to the decision tree, and the actual TUG data was used as ground truth labels. The decision tree was constructed to assign each patient to one of three categories: “TUG

PURPOSE OF REVIEW: To explore state-of-the-art remote monitoring and emerging new sensing technologies for in-home physical assessment and their application/potential in cancer-care. In addition, we discuss the main functional and non-functional requirements and research challenges of employing such technologies in real-world settings. RECENT FINDINGS: With rapid growth in aging population, effective and efficient patient care has become an important topic. Advances in remote monitoring and in its forefront in-home physical assessment technologies play a fundamental role in reducing the cost and improving the quality of care by complementing the traditional in-clinic health-care. However, there is a gap in medical research community regarding the applicability and potential outcomes of such systems. SUMMARY: While some studies reported positive outcomes using remote assessment technologies such as web/smart phone based self-reports and wearable sensors, the cancer research community is still lacking far behind. Thorough investigation of more advanced technologies in cancer-care is warranted.

Background The prevalence of age-related impairments in older patients (pts) undergoing hematopoietic cell transplantation (HCT), and its relationship with transplant outcomes is largely unknown. Methods In a pilot quality improvement project, assessment of functional, social, emotional, cognition, sensory, nutritional and polypharmacy domains was performed using an electronic rapid fitness assessment (eRFA) developed at MSKCC (Shahrokni JNCCN 2017). Older adults (age ≥ 60 years) undergoing HCT for hematologic malignancies from 2015 through 2018 in 2 transplant clinics were included. The prevalence of geriatric impairments, transplant-associated toxicities and survival were analyzed under an IRB approved waiver of authorization. Results Patient characteristics are shown in Table 1. The median day from eRFA to HCT was 45 days (range 14-162). Median time to complete eRFA was 10 minutes. Table 2 has a summary of geriatric impairments. Majority of pts (n=33) had at least 1 impairment. The most prevalent were social, emotional, polypharmacy and functional. Median number of geriatric impairments per patient was 4 (range 0-9). Median toxicities per patients was 4 (range 0-12). The most common toxicities were: 25 metabolic, 22 infections, 21 oral/gastrointestinal, and 16 cardiopulmonary. The only pt admitted to the ICU was an allo-HCT pt with 5 impairments. Amongst the 8 pts (4 AHCT, 4 allo-HCT) readmitted to the hospital within the first 100 days of HCT, the median number of impairments was 4 (range 0-9). Seven patients died, 5 from disease, and 2 from GvHD. With a median follow up of 9 months (range 1-38) among survivors, the 18-months progression-free and overall survival were 0.71 (0.55-0.91) and 0.7 (0.51-0.95) respectively (Figure 1). Conclusions Performing pre-HCT eRFA among older transplant patients is feasible. With the median completion time of 10 minutes, the eRFA can identify geriatric impairments of this vulnerable population. Future larger studies should assess whether these impairments have association with the outcomes, and whether interventions to improve geriatric impairments also improve transplant outcomes.