One size doesn't FIT all: Early outcomes of implementing the ASCO PGA in an Australian public hospital.

Abstract

Background: Older people present with impairments and pre-existing illnesses contributing to higher risks of cancer treatment complications, toxicities, unplanned hospitalisation and poorer quality of life. Failure to identify these vulnerabilities restricts access to safe and high-quality patient-centred health care. Geriatric assessment provides valuable information about domains that are typically neglected in routine practice. The results equip cancer professionals with the knowledge and confidence to administer treatment and supportive care targeted to the elderly patient. Each year, Monash Health treats approximately 6, 000 new cancer patients with 70% aged 60 years and older and 25% are non-English speaking. Amid a chronic shortage of staff and funding, we identified ASCO's Practical Geriatric Assessment (PGA) as a feasible tool to use in the geriatric oncology setting. Method(s): Starting in 2024, FIT (Frailty Informed Treatment) is an ongoing observational study utilising the PGA in new patients aged 65 and above attending the GI clinic for consideration of systemic therapy. The PGA is administered prior to the patient's first medical oncology visit. The results of the PGA and other information emerging from a review of the electronic medical record (EMR) are discussed at a weekly multidisciplinary meeting (MDM), comprising a geriatric oncologist, geriatrician, nurse practitioner, nurse navigator and project manager (dietitian). The MDM recommendations are clearly labelled in the EMR. Result(s): 37 PGAs have been undertaken, with the mean age of patients 72 years (65 to 84 years), 65% are male and 73% English speaking. Results are summarised below and have led to 58 supportive care referrals.Further data will be available before ASCO 2025. (Anticipate 50 PGA's completed plus user satisfaction survey). Conclusion(s): The PGA is straightforward to administer, easily understood by patients and providers and assist a patient-centred approach. They improve oncologists' awareness of geriatric vulnerabilities, encourage early uptake of supportive care, and enable a tailored approach to treatment. We hope to expand the model of care across our organisation. Impairments identified by PGA.PGA Domains & Measures of Impairmentn (=37)%Physical Function/Performance Falls ( >= 1)514% Walking one block/ stairs (any limitation)2054% 4 metre Gait Speed (time >4 secs)2259%Functional Status OARS Instrumental/ADL's ( needs some help/unable)2362%Social Supports MOS social supports ( none, a little, some of the time)822%Psychological PROMIS anxiety 4 items (raw score >= 11)1541% Geriatric Depression Scale 5 ( score >= 2)1335%Nutrition MNA Score (Score 0 = >= 3kg weight loss)1438%Comorbidity Comorbidities (>= 3)2054% Vision (fair /poor/ blind)616% Hearing (fair /poor/ deaf)1130%Cognitive Function Mini-cog ( <= 2)25%Chemotherapy Toxicity CARG chemo toxicity score (mod and high risk >= 6)2054%Copyright © 2025