Frailty is prevalent in older adults with cancer and has been associated with adverse outcomes including treatment-related toxicity, functional decline, progressive frailty, reduced quality of life and mortality. While models of care have varied in how geriatric assessments and frailty screening measures can be incorporated into clinical practice, they are consistent in that they often reveal unrecognised geriatric impairments, influence treatment decisions, and predict adverse outcomes. International groups have therefore advocated for a greater focus on patient-centred care and health-related quality of life outcomes in clinical design for this vulnerable population. Over the last five years, evidence has emerged supporting the benefit of geriatric assessments and intervention strategies to not just predict vulnerabilities, but to improve patient-centred outcomes.
An appreciation of an individual’s vulnerabilities, frailty, and resilience provides an opportunity for clinicians to address potentially reversible impairments, provide additional supportive measures, modify therapy, and to revisit or refocus goals of care. Open discussion regarding goals of care is integral, as research has found frequent discordance between clinician- and patient-identified goals. Many patients with life-limiting diseases may decline therapies associated with the risk of functional or cognitive decline, whereas others may accept these risks for even a small survival benefit. Older people have a strong desire to be informed and involved in decision making, and contextualising frailty has been shown to improve doctor-patient communication regarding age-related concerns.
Patient-identified goals present an intriguing avenue for exploring the potential benefits of comprehensive geriatric assessment. The specific nature of these goals in frail older adults with cancer, as well as clinical experience gained in using these as patient-nominated outcomes, rather than patient-reported outcomes, is explored.