Abstract
PURPOSE: To guide clinicians and policymakers in global resource-constrained settings to assess the geriatric needs of patients older than 65 years with cancer when Maximal-setting guideline-recommended resources are unavailable. METHODS: A multidisciplinary, multinational Expert Panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes. RESULTS: An ASCO resource-neutral guideline was adapted for resource-constrained settings, informing one round of formal consensus; recommendations received ≥75% agreement. RECOMMENDATIONS: The Expert Panel endorses the Maximal-setting guideline's overarching recommendation that end users utilize geriatric assessment (GA), including essential domains, to identify "vulnerabilities or impairments not routinely captured in oncology assessment for all older patients over 65 years old with cancer." All care plans for patients with cancer over 65 years old receiving systemic therapy with GA-identified deficits should include GA-guided management. A geriatric evaluation should at a minimum include the use of a brief geriatric screening tool. Tools in the Practical Geriatric Assessment (PGA) are validated in multiple languages, but users may use more appropriate tools in some settings and languages, if they include the relevant guideline-specified domains. Maximal-resource settings of high-income countries have traditionally developed cutoffs for GA-identified deficits, but locally validated research and practice may inform differing cutoffs. If validated all-cause mortality prognosis tools do not adequately represent the setting, clinicians may use actuarial life-expectancy tables with quartiles of overall health status.Additional information can be found at www.asco.org/global-guidelines. It is the view of ASCO that health care clinicians and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.