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Beyond Treatment Decisions: The Predictive Value of Comprehensive Geriatric Assessment in Older Cancer Patients
by
, , , , ,
Eleonora Bergo
1,†
,
Marina De Rui
2,3,†,
Chiara Ceolin
2,3,4,
Pamela Iannizzi
1,*,
Chiara Curreri
2,
Maria Devita
2,5,
Camilla Ruffini
6,
Benedetta Chiusole
6,
Alessandra Feltrin
1,
Giuseppe Sergi
2,3 and 
Antonella Brunello
6
1
Hospital Psychology, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy
2
Division of Geriatrics, DIDAS Medicine Department, University Hospital of Padua, 35128 Padua, Italy
3
Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy
4
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, 17165 Stockholm, Sweden
5
Department of General Psychology—DPG, University of Padua, 35131 Padua, Italy
6
Department of Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2025, 17(15), 2489; https://doi.org/10.3390/cancers17152489
Submission received: 20 June 2025
/
Revised: 17 July 2025
/
Accepted: 24 July 2025
/
Published: 28 July 2025
(This article belongs to the Section Clinical Research of Cancer)
Simple Summary
The increasing life expectancy poses a number of challenges for clinicians, particularly in oncology. Evaluating frailty among older patients is essential for predicting the outcomes of oncological treatments. This study aimed to identify the elements of the Comprehensive Geriatric Assessment (CGA) that most influence decisions about anti-cancer treatment for older patients and explore the CGA’s predictive value for mortality. We identified the key CGA elements that aid clinicians in making therapeutic decisions regarding anti-cancer treatments for older adults, as well as their role as independent predictors of mortality. Functional capacity was identified as a significant predictor of mortality within four years, alongside geriatric depression and living arrangements. These findings emphasize the importance of multidimensional geriatric assessments in the management of older cancer patients.
Abstract
Background: Comprehensive Geriatric Assessment (CGA) is essential for evaluating older cancer patients, but significant gaps persist in both research and clinical practice. This study aimed (I) to identify the CGA elements that most influence anti-cancer treatment decisions in older patients and (II) to explore the predictive value of CGA components for mortality. Methods: This observational study included older patients with newly diagnosed, histologically confirmed solid or hematological cancers, recruited consecutively from 2003 to 2023. Participants were followed for four years. The data collected included CGA measures of functional (Activities of Daily Living-ADL), cognitive (Mini-Mental State Examination-MMSE), and emotional (Geriatric Depression Scale-GDS) domains. Patients were categorized into frail, vulnerable, or fit groups based on Balducci’s criteria. Statistical analyses included decision tree modeling and Cox regression to identify predictors of mortality. Results: A total of 7022 patients (3222 females) were included, with a mean age of 78.3 ± 12.9 years. The key CGA factors influencing treatment decisions were ADL (first step), cohabitation status (second step), and age (last step). After four years, 21.9% patients had died. Higher GDS scores (OR 1.04, 95% CI 1.01–1.07, p = 0.04) were independently associated with survival in men and living with family members (OR 1.67, 95% CI 1.35–2.07, p < 0.001) in women. Younger patients (<77 years) showed both MMSE and GDS as significant risk factors for mortality. Conclusions: Functional capacity, cohabitation status, and GDS scores are crucial for guiding treatment decisions and predicting mortality in older cancer patients, emphasizing the need for a multidimensional geriatric assessment.
