Table 1. Details of the tools used, assessments performed and questionnaires administered as a part of the GA at the Tata Memorial Hospital (Mumbai, India).
| GA tool | Scale | Cut-off to define an abnormal value (vulnerability in the GA) |
|---|---|---|
| Function | ||
| Activities of daily living (ADL) | Katz ADL [25] | <6 |
| IADL | Lawton IADL [26] | Men <5 Women <8 |
| Performance-based assay | Timed-up-and-go [27] | >10 seconds |
| Risk of falls | Single question: ‘How many falls have you had in the past one year?’ | >1 |
| Nutrition | ||
| Body mass index | Weight (kg)/height2 (meter) | <18.5 kg/m2 |
| Unintentional weight loss | Proportion of weight lost as compared to the pre-illness baseline | >10% |
| Nutritional status | MNA [28] | <24 (24–30: Normal nutrition; 17–23.5: At risk of malnutrition; <17: Malnourished) |
| Comorbidities | ||
| Presence of comorbidities | Hypertension, diabetes, chronic airway disease, coronary artery disease, any other comorbidity | Specific comorbidity is documented |
| Validated comorbidity tools | Charlson comorbidity index [29] | >2 |
| Validated comorbidity tools | CIRS-G [30] | >4 Any category score: 3–4 Severity index (total score/number of scales with score >0) >2 |
| Cognition | ||
| Literate patients | MMSE [31] | <24 (24–30: no cognitive impairment; 18–23: mild cognitive impairment; 0–17: severe cognitive impairment) |
| Illiterate patients | Hindi mental status examination [32] | |
| Mood | ||
| Depression | GDS-short form [33] | >4 (5–8: mild depression; 9–11: moderate depression; 12–15: severe depression) |
| Anxiety | GAD-7 [34] | >10 (0–4: minimal anxiety; 5–9: mild anxiety; 10–14: moderate anxiety; >15: severe anxiety) |
| Medications | ||
| Polypharmacy | Number of regular medications | >5 medications [35] |
| PIM | American geriatrics society beers criteria [36] | Any PIM |
| Social support | ||
| Validated tool | Older Americans resources and services medical social support [37] | >1 (in questions 2–4) |
| Living situation | Resident of Mumbai/staying with relative, or in a rented room or hotel/guest house of ashram/homeless/staying on the footpath | Homeless or staying on the footpath |
| Number of caregivers | ‘How many persons are available to care for you all the time, or most of the time, or at the times that you need a caregiver?’ | 0 |
| Screening tools | ||
| Geriatric 8 (G8) [38] | <12 | |
| Vulnerable elders survey-13 (VES-13) [39] | >3 | |
| Rockwood clinical frailty scale [40] | >5 | |
| Chemotherapy toxicity risk prediction score | CARG chemo-toxicity calculator [41] | Low risk (30%)*: 0–5 Intermediate risk (52%)*: 6–9 High risk (83%)*: >10 [42, 43] |
| Non-cancer life expectancy | ePrognosis (Lee and Schonberg indices) [44] | Estimate of the 5-year and 10-year mortality (non-cancer related) and the life expectancy in years |
| QoL | The European Organisation for Research and Treatment of Cancer QLQ-C30, v3.0 [45] | Higher score indicates a better QoL |
| EORTC QLQ-ELD14 [46] | Higher scores on ‘Maintaining purpose’ scale and ‘Family support’ item indicates a high level of functioning; higher scores for ‘Mobility’, ‘Worries about others’, ‘Future worries’, ‘Burden of illness,’ and ‘Joint stiffness’ indicate a poor QoL |
|
| Caregiver QoL | (Fronto temporal lobe disorders) Caregiver burden scale | >20 (0–20: little or no burden; 21–40: mild to moderate burden; 41–60: moderate to severe burden; 61–88: severe burden) |
| General assessments | ||
| Vision | ||
| Distant vision | Snellen chart | 6/18 or worse |
| Near vision | Landolt C chart | N/18 or worse |
| Hearing | ||
| Questionnaire | Hearing handicap index [47] | >10 (0–8: no handicap; 10–24: mild to moderate handicap; 26–40: severe handicap) |
| Voice | Voice handicap index [48] | >11 |
| Oral health | Geriatric oral health assessment index [49] | Total score: 12–60; higher scores indicate better perception of oral-dental health |
| Cancer-related symptoms | Edmonton symptom assessment scale [50] | Any score >4 |
| Financial burden | ||
| Comprehensive score for financial toxicity-functional assessment of chronic illness therapy (COST-FACIT) [51] | <12 (≥26: no impact on QoL (grade 0); 14–25: mild impact (grade 1); 1–13: moderate impact (grade 2); 0: high impact (grade 3)) |
|
| Consumer financial protection bureau financial well-being scale [52] | Range: 0–100 points; Lower scores represent worse financial well-being | |
| Patients’ and caregivers’ viewpoint regarding disclosure | ‘Does the patient/caregiver want the treating team to disclose and discuss the diagnosis and prognosis?’ | Based on the patients’ and caregivers’ viewpoints, the results of the GA, the curability/treatability of the cancer and the potential toxicity of the therapy, a discussion occurs |
| Patients’ expectations from treatment | If curative: Complete cure/symptom control/improvement in present status/improved QoL or prolongation of life If palliative: Improved QoL/prolongation of life/immediate symptom relief |
|
| Blood tests | ||
| eGFR | Based on the kidney function, a decision will be taken | |
| NLR | NLR <3.4 = Poor prognosis | |
| Vaccination status | Uptake of pneumococcal, influenza, and COVID-19 vaccines | If not received, patients are advised these vaccines |
*
Risk of grade 3 or higher toxicity