Table 1.

Review characteristics

First Author (Year)	Meta-analysis (Y/N)	Review aim(s)	Age of eligible patients	Age of included participants	Cancer type; stage; treatment	Number of included studies (articles)	Outcomes or objectives	Key Findings
Puts (2012) [14]	N	(i) to provide an overview of all GA tools used in oncology settings, (ii) to examine the feasibility and psychometric properties of the GA tools, and (iii) to systematically evaluate the impact of GA tools in predicting or modifying outcomes	mean or median age of study participants ≥ 65	Patients: 65–99 years	Heterogenous; Heterogenous; Heterogenous	73 (83)	i. overview of GA instruments developed and/or used, ii. feasibility of GA iii. impact of GA on treatment decisions iv. associations/predictive value of GA on treatment complications or toxicity, vi. predictive value of GA on mortality v. association between GA domains and healthcare utilisation	• Common tools used to assess domains within a GA included Katz (ADL), Lawton (IADL), CCI or CIRS-G (comorbidity, MMSE (Cognition), GDS (Depression), MNA or BMI (nutrition), ECOG or Karnofsky (Performance Status), Self-reported falls (Falls risk) • GA generally took 10–45 min. • Short form GA generally had good diagnostic accuracy. • Changes to treatment plans for 40–50% of patients following GA (2/4 studies). • Impairments on at least one GA domain were associated with treatment toxicity or complications (reported in 6/9 studies), mortality (in 8/16 studies), health care use in two studies • Various GA domains associated with treatment toxicity and mortality.
Puts (2014) [23] – Update to Puts 2012	Y	(i) to provide an overview of all GA tools used in oncology settings (ii) to systematically evaluate the impact of GA tools on the treatment decision-making process and their effectiveness in predicting pr modifying outcomes	mean or median age of study participants ≥ 65	Patients: 55–99 years	Heterogenous; Heterogenous; Heterogenous	34 (35)	i. overview of GA instruments developed and/or used, ii. impact of GA on treatment decisions iii. associations/predictive value of GA on treatment complications or toxicity, iv. predictive value of GA on mortality v. association between GA domains and healthcare utilisation	• Common domains assessed within a GA included ADL, IADL, comorbidity, depression, and cognitive function. • Meta-analysis across six studies demonstrated GA modified treatment decisions in 23.2% (weighted percent modification) • Heterogenous results on predictive value of GA on treatment toxicity or complications in seven studies, and mortality in eleven studies. • One study reported association between increasing frailty and increased cost of care
Hamaker (2012) [30]	N	to summarize all available evidence on the association between GA and oncological outcomes	No limit	Patients: 18–99 years	Heterogenous; Heterogenous; Heterogenous	37 (51)	i. predictive value of GA on all-cause mortality ii. chemotherapy toxicity iii. chemotherapy completion iii. association between GA and perioperative complications v. association between GA and radiotherapy toxicity/completion	• Median of five geriatric domains assessed per study. • Frailty (in 9/10 studies), nutritional status (in all four studies), comorbidity assessed using CIRS-G (in 4/5 studies) predicted mortality. • Frailty (in 2/3 studies) predicted chemotherapy toxicity. • Impairment in cognition (in 2/3 studies), comorbidity (in 2/3 studies), ADL impairment (in 2/3 studies) was associated with chemotherapy completion. • Impairment in IADL (in 3/4 studies) was associated with peri-operative completion. • No studies found reporting on association between GA and radiotherapy toxicity/completion
Hamaker (2014) [15]	N	to summarise data on the effect of a geriatric evaluation (GE) on oncologic treatment decisions and implementation of non-oncologic interventions for older adults with cancer	No limit	Patients: 70–99 years	Heterogenous; Heterogenous; Heterogenous	10 (10)	i) changes in treatment plan ii) number and type of non-oncologic interventions	• Frequently detected conditions were polypharmacy (median 67%), malnourishment (median 63%), functional impairments (IADL median 45%, ADL median 43%, mobility/falls median 33%), depressive symptoms median 34%, somatic comorbidity and cognitive impairments, followed by social issues (social isolation, caregiver burden; median 21%). • Effect of GE on treatment decisions considered in six studies. Treatment changes for approximately 39% of patients after a GA, with two thirds of these changes made to a less intensive treatment option. • Non-oncologic interventions were recommended to over 70% of patients across seven studies. • Frequently recommended interventions were social interventions (median 38%), modification to medication (median 37%), followed by nutritional interventions (median of 26%). Intervention for psychological, cognitive, impairments, mobility/falls risk or comorbidity were all recommended for a median of 20% of patients.
Hamaker (2018) [39] - Update to Hamaker 2014	N	to summarize all currently available data on the effect of a GE on oncologic treatment decisions, the implementation of non-oncologic interventions and the impact on treatment outcome for older adults with cancer	No limit	Patients: Mean/Median age 74–83 years	Heterogenous; Heterogenous; Heterogenous	35 (36)	i) changes in oncologic treatment plan ii) number and type of non-oncologic interventions iii) effect of GE on treatment outcomes (toxicity, treatment-related complications, completion, quality of life or physical functioning, mortality, and health care utilisation)	• Eleven studies compared treatment decision before and after GE and reported median change to 28% of patients (range 8–54%). Mostly to a less intensive treatment option. • Nineteen studies reported on non-oncologic interventions. Common intervention included addressing social issues (median 39%), nutrition (median 32%) and polypharmacy (median 31%). GA-based interventions were recommended to a median of 70% of patients. • Thirteen studies reported on the effect of GE on treatment outcomes. Positive effect on treatment completion (higher completion in 3/4 studies), and treatment toxicity or complications (positive effect in 5/9 studies), lower rates of mortality (2/7 studies), heterogeneous results for health care use (in 8 studies) • Two of three RCTs found positive effect of GE on quality of life or physical functioning
Hamaker (2022) [40] – Update to Hamaker 2018	N	to summarize currently available data on the effect of a GA on oncologic treatment decisions, the implementation of non-oncologic interventions, doctor-patient communication, and the impact on treatment outcome. A second aim was to assess differences in impact based on the way the geriatric assessment is implemented.	No limit	Patients: Mean/Median age 68–83 years	Heterogenous; Heterogenous; Heterogenous	61 (65)	i) changes in oncologic treatment plan ii) number and type of non-oncologic interventions iii) effect of GA on patient-doctor communication iv) effect of GA on treatment outcomes (i.e., toxicity, treatment-related complications, completion, mortality, health care utilisation, quality of life or physical functioning)	• Across twenty-one studies, treatment decisions were modified in a median of 31% of patients (range 7–56%), mostly to less intensive treatment option. Modifications were higher when conducted by multidisciplinary team compared to assessment by oncology team or geriatric consultation. • Thirty-three studies reported on GA-based interventions. One or more interventions were recommended to a median of 72% of patients. • Across three RCTs, GA led to more age-related discussions, care planning and improved communication. • Twenty-one studies reported on effect of GA on treatment outcomes. In most studies, GA led to lower treatment toxicity/complications, higher treatment completion (in 6/9 studies) and improved quality of life (in 4/6 studies) or physical functioning (in all three studies)
Ramjaun (2013) [33]	N	to identify CGA domains that are most predictive of clinical outcomes in patients ≥ 65 years receiving treatment for non-metastatic cancer.	≥ 65 years	Patients: Not reported	Heterogenous; NR; Heterogenous	9 (9)	i) post operative complications ii) chemotherapy-related toxicity iii) mortality	• One study reported association between comorbidity measured by CIRS-G and post-operative complications (OR = 5.62, 95% CI 2.18–14.50) • Treatment-related toxicity examined in three studies. Functional status (OR 1.71 to 2.47) and impaired hearing (OR = 1.67, 95% CI 1.04–2.69) associated with treatment-related toxicity. • At least one or more domains of CGA significantly predicted mortality (7 studies).
Versteeg (2014) [31]	N	to summarise the data on the predictive value of GA on treatment toxicity, mortality and treatment decisions in elderly patients with solid cancer treated with chemotherapy	≥ 65 years	Patients: 65–99 years	Heterogenous; NR; Chemotherapy	13 (13)	i) treatment toxicity ii) mortality iii) influence of GA on treatment decision-making	• Six studies reported on predictive value of GA and treatment toxicity. Inconsistencies across studies in terms of domains that predicted toxicity. 49–64% of older patients experience chemotherapy-related toxicity (at least grade 3) • Malnutrition, impairment in functional status and comorbidities, lower performance status and frailty associated with mortality. Malnutrition is the only factor to predict mortality across all studies. • Across five studies, treatment modifications were made to 21–53% of patients following GA. Impairment in functional status or malnutrition were common reasons for treatment modifications.
Caillet (2014) [24]	N	to review evidence on the usefulness of CGA in assessing health problems, guiding decisions about cancer treatments, predicting outcomes, and developing a coordinated program of tailored geriatric interventions.	≥ 65 years	Patients: 65–99 years	Heterogenous; NR; Heterogenous	35 (35)	i) number of health issues identified following a CGA ii) predictive value of CGA on mortality iii) predictive value of CGA on chemo-toxicity iv) impact of CGA on treatment decision-making v) CGA based care plans	• CGA identified a number of geriatric problems that could affect or interfere with treatment. • 21–49% of treatment decisions were influenced by a CGA. Five studies suggested function and nutritional status have the strongest effect. • Functional impairment, malnutrition and comorbidities were common predictors of mortality and chemotherapy-related toxicity. • Few studies described interventions following CGA results. Only three RCTs reported on effect of GA-based intervention with mixed results.
Feng (2015) [32]	N	to assess which components of the CGA predict clinically relevant outcomes in geriatric surgical oncology	≥ 60 years	Patients: 60+	Solid tumours; NR; Surgery	6 (6)	i) predictive value of GA on 30-day post-surgical mortality, complications within 30-day, and discharge to an institution ii) predictive value of GA on 90-day all-cause mortality	• Impairment in IADL, ADL, fatigue, cognition, depression and frailty predicted overall/major post-operative complications. • No CGA components predicted postoperative mortality (assessed in 4/6 studies) • Impairments in IADL and depression predicted discharge to a non-home institution (assessed 2/6 studies) • Various impairment predicted longer length of stay.
Schulkes (2016) [25]	N	to assemble all available evidence on the relevance of the GA in treatment decisions, outcome prediction, and the prevalence of geriatric conditions in older patients with lung cancer.	No limit	Patients: 73–81 years	Lung cancer; heterogenous; heterogenous	18 (23)	i) prevalence of geriatric conditions ii) predictive value of GA and mortality, iii) association of GA with chemo-toxicity, treatment response iv) predictive value of GA and treatment completion v) effect of GA results on decision-making vi) effect of GA on function or cognitive status during or after treatment, quality of life	• Prevalence of geriatric conditions in older adults with lung cancer was high, median range 29% for cognitive impairment to 70% for impairment on IADL • Objective physical function and nutritional status were commonly associated with mortality (6/10 studies) • Few significant associations found between GA domains and chemotherapy-related toxicity (noted across five studies). • Two studies looked at the correlation between treatment response and GA, however there was no signification association. • Two of four studies found an association between impairment in GA domains and treatment completion. • Treatment modification and implementation of non-oncologic interventions were made based on a GA across four studies.
Molina-Garrido (2017) [29]	N	to assemble all the evidence on the models of CGA, frailty screening tools which have been used in elderly patients with prostate cancer and their feasibility	No limit	Patients: 65–93 years	prostate cancer; NR; NR	8 (8)	i) prevalence of geriatric conditions ii) describe models of CGA iii) feasibility of screening tools	• Geriatric impairments are prevalent in older adults with prostate cancer • No consensus on CGA model to be used for older adults with prostate cancer • One study reported on association between basal information from CGA and early discontinuation, another article reported on association between frailty (based on CGA) and survival, treatment toxicity • Two studies reported that the VES-13 screening tool correctly identified frail patients (72.6–90% accuracy).
van Deudekom (2016) [44]	N	to study the association of functional, cognitive impairment, social environment, and frailty with adverse health outcomes in patients with head and neck cancer.	No limit	Patients: 46.3–78 in 27/31 studies that reported on mean patient age	Head and Neck; Heterogenous; Heterogenous	31 (31)	i) adverse health outcomes defined as mortality, functional or cognitive decline ii) adverse events during or after treatment iii) prolonged length of stay iv) health-related quality of life	• Impairment in functional status, depression symptoms and social isolation are prevalent in head and neck cancer patients. • Most studies reported significant association in impairment in function, cognition, mood or social environment with adverse outcomes • Cognitive function (reported in 2/31 studies), frailty and objectively measured physical function were not assessed for all head and neck cancer patients
van Deudekom (2018) [43]	N	to study the association of functional, cognitive impairment, social environment, and frailty prior to any treatment with adverse health outcomes after follow-up) in patients diagnosed with esophageal cancer	No limit	Patients: 55.23–79.5 in the 17/19 studies reporting on mean patient age	esophageal cancer; Heterogenous; Heterogenous	19 (19)	i) adverse health outcomes defined as mortality, functional or cognitive decline ii) adverse events during treatment iii) prolonged length of stay iv) health-related quality of life	• Impairment in function, cognition, frailty were significant associated with adverse health outcomes (19/53 studies) • Functional impairment or social environment significantly associated with adverse health outcomes (4/6 studies) • Objectively measured physical function, cognition (measured in 1/19 studies), and frailty was not measured in all eseophageal cancer patients
Szumacher (2018) [26]	N	(i) to provide an overview of all CGA instruments and geriatric screening tools that are used in the radiation oncology setting; (ii) to examine the feasibility and psychometric properties of CGA and screening tools and (iii) to systematically evaluate the impact of CGA instruments and geriatric screening tools on the radiation therapy treatment decision-making process and their effectiveness in predicting cancer and treatment outcomes	mean or median age of study participants ≥ 65	Patients: 61–95 years	Heterogenous; Heterogenous; Radiotherapy	12 (12)	i) overview of CGA instruments and screening tools used in radiation oncology, ii) feasibility CGA instruments and tools iii) psychometric properties or diagnostic accuracy of instruments iv) impact of CGA and tools on treatment decision-making process v) predictive value of GA for cancer and treatment outcomes	• VES-13 and G8 were the most frequently used screening tools across five studies (standalone in two, and referrals to CGA in three studies) • A CGA was used in seven studies, a geriatrician-led assessment in four of the seven studies, and other studies patient self-administered. • CGA required 80–120 min to complete (reported across three studies) • One study reported treatment modification based on CGA for five of six patients. “• There were a non-significant association between CGA impairment and treatment tolerance (in 6 studies). • Two studies identified relationship between CGA and treatment completion • Two studies reported correlation between mortality and lower G8 score and nutritional risk.
Hamaker (2013) [27]	N	to determine relevance of GA for older patients with haematological malignancy and domains that are predictive of patient and cancer-related outcomes	No limit	Patients: 58–86 years	Haematological; N/A; Heterogenous	15 (18)	i) prevalence of geriatric conditions in haematological setting ii) predictive value of GA for mortality iii) association of GA with other outcomes (e.g., chemo-toxicity, response rates, treatment completion, changes to GA during/after treatment)	• Prevalence of geriatric conditions was high despite good performance status • Predictive value of GA for mortality reported in ten studies. Impairments in IADL (55%), cognition (83%), physical function (100%) and malnutrition (67%) were associated with mortality. Objective physical function and nutritional status retained significance in multivariate analysis. • Varying results for toxicity and response rates. • Poor performance status, palliative treatment intent and renal dysfunction were associated with treatment non-completion in multivariate analysis (reported in a single study). • Improvements on fatigue/depressive symptoms/subjective health measures (based on changes in GA during and after induction chemotherapy) was reported across two studies.
Bruijnen (2019) [16]	N	to determine which domains of a GA predict patient- and treatment-related outcomes and therefore should be included within a GA	≥ 65 years	Patients: 65–99 years	Heterogenous; Heterogenous; Heterogenous	46 (46)	i) predictive value of GA domains patient-related outcomes (defined as mortality, post-operative complications) ii) predictive value of GA domains for treatment-related outcomes (defined as toxicity, dose modification, early withdrawal)	• At least one of the following domains: functional status, nutrition, cognition, mood, physical function, fatigue, social support and falls, predicted mortality, postoperative complications, or treatment-related outcomes. • Physical function as consistent predictive domain of mortality, chemotherapy-related outcomes, and postoperative complication.
Salazar (2019) [34]	Y	to gather, evaluate, and synthesize all available evidence on the effectiveness of GA and frailty scores in predicting mortality and drug toxicity in patients receiving treatment for multiple myeloma.	NR	Patients: mean age 58–74 years	Multiple myeloma; NR; Heterogenous	7 (7)	i) predictive value of GA and frailty scores and treatment-related toxicity ii) predictive value of GA and frailty scores and mortality	• ADL, IADL, CCI, R-MCI, HCT CI and KFI were domains included in the GA across seven studies. • Three studies reported association between GA and treatment-related toxicity. Two studies reported similar risks of grade 3 + haematologic adverse events in intermediate fit and frail patients compared to fit patients. • Predictive value of GA and mortality reported in all studies, common domains predictive of mortality included: comorbidity, functional status and frailty scores. • Meta-analysis of three studies (3/7) reported increased risk of mortality for patients who had an activity of daily living score ≤ 4. Based on frailty scores, increased risk of mortality for frail patients compared to fit patients.
Scheepers (2020) [28]	N	to give an update of all currently available data on the association between geriatric impairments and hematologic cancer-related outcomes.	No limit	Patients: me(di)an age 58–86 years	Haematological; N/A; Heterogenous	44 (54)	i) prevalence of GA impairments for patients with haematological cancers, ii) association between GA impairment and treatment completion; chemotherapy-related toxicity; healthcare utilization; physical functioning after treatment; quality of life after treatment; mortality	• Polypharmacy, risk of malnutrition, IADL impairments, impaired physical capacity, ADL impairments, symptoms of depression and cognitive impairment were commonly reported geriatric impairments. • Frailty (defined by screening tool or summarising GA) was associated with mortality, treatment-related toxicity and non-completion. • Six of ten studies reported associations between GA and treatment-related toxicity. Four studies reported association between frailty (summarised GA) and toxicity. • Four of five studies reported association between geriatric impairment and treatment completion. Frailty was associated with higher risk of treatment non-completion. • Six of seven studies reported association between geriatric impairment and healthcare use. Impaired physical capacity commonly associated with healthcare utilisation (reported in 4/6 studies). • Quality of life hardly assessed in included studies.
Xue (2018) [36]	Y	to conduct a meta-analysis to identify the effectiveness of CGA for predicting postoperative complications in gastrointestinal cancer patients.	≥ 65 years	Patients: mean age 64 to 81.5 years	gastrointestinal cancer; NR; surgery	6 (6)	i) predictive value of CGA on postoperative complications (defined as 30-day postoperative complications, 30-day major postoperative complications, 90-day major postoperative complications)	• Meta-analysis (6 studies) identified predictive value of comorbidity, polypharmacy and impairments ADL with 30-day postoperative major complications in gastrointestinal cancer patients. • Polypharmacy, pain, weight loss were related to 90-day postoperative major outcomes (reported in 1/6 studies)
Szabat (2021) [35]	N	to summarize results of studies investigating individual domains of GAs and the GA among older patients undergoing laparoscopic surgery.	≥ 65 years	Patients: N = 3 ≥ 65 N = 4 ≥ 70 N = 3 ≥ 75	Heterogeneous (Colorectal cancer in 6 articles, various solid abdominal cancer in 3 articles); NR; surgery	10 (10)	i) predictive value of GA domains and GA as a whole on postoperative complications	• Inconsistencies across individual domains that predicted postoperative complications. • Impairment in functional status was a reliable predictor for risk of postoperative complications. • Authors confirmed effectiveness of cumulative GA in predicting postoperative complications following laparoscopic surgery.
Couderc (2019) [45]	N	to review the data available on most frequently used tools to assess ADL and IADL in a geriatric oncology setting and their predictive values on overall survival, toxicity, treatment feasibility or decisions, and postoperative complications	mean age over 70 years	Patient: NR	Heterogenous; Heterogenous; Heterogenous	40 (40)	i) tools used to assess ADL, IADL ii) predictive value of tools on overall survival, toxicity, treatment feasibility or decision and postoperative complication	• The most used tool to assess ADL was the Katz, and for IADL, the Lawton scale. The loss of ability to perform at least one activity on the Katz was used as the cut-off (i.e., categorise patient as dependent or independent), the same cut-off was used for the Lawton scale. • Functional status predicted mortality in eleven of twenty-two studies, treatment feasibility in 2/5 studies, changes in treatment decisions for 2/3 studies and postoperative complications in 4/6 studies. Following a regression analysis, functional status was significantly associated with chemotoxicity in 2/7 studies.
Chuang (2022) [37]	Y	to evaluate whether implementation of a CGA could reduce treatment-related toxicity in older patients undergoing non-surgical cancer treatments	≥ 65 years	Patients: N = 5 ≥ 70 N = 1 ≥ 65	Heterogenous; Heterogenous; Heterogenous	6 (6)	i) impact of CGA-based intervention on incidence of Grade 3 + adverse events measured by the Common Terminology Criteria for Adverse Events (i.e., treatment-related toxicity) Secondary outcomes: i) association with early discontinuation of treatment ii) impact on treatment modification iii) treatment delay and hospitalisation iv) progress-free and overall survival	• Meta-analysis demonstrated association with CGA-based interventions and reduced incidence of Grade 3 + toxicity, and a lower rate of reducing treatment dosage during treatment compared to usual care. • No significant difference for early treatment discontinuation, treatment modification (i.e., reduction in treatment intensity), treatment delay or hospitalisation or mortality between CGA-based interventions and control groups.
Anwar (2023) [41]	Y	to synthesize information on the effectiveness and cost-effectiveness of comprehensive geriatric assessment (with or without implementation of recommendations) compared with usual care	≥ 65 years	Patients: mean age 72–80 years	Heterogenous; Heterogeneous; Heterogenous (chemotherapy n = 4, surgery n = 3, radiotherapy n = 1, combination of treatments n = 9)	17 (19)	i) mortality ii) hospitalization, readmission iii) treatment toxicity iv) change in treatment v) quality of life and functional status vi) cost-effectiveness (any type of economic evaluation and outcomes and cost-effectiveness measures)	• Meta-analysis of 17 RCTs found that treatment toxicity was significantly lower in intervention group compared to usual care, however no differences reported for mortality risk, treatment reduction, early treatment discontinuation and hospitalisation • No significant differences in functional outcomes between intervention and control group reported across 8 RCTs • Only 6 RCTs evaluated quality of life, with mixed results reported. • No studies reporting on cost-effectiveness
Disalvo (2023) [38]	N	To summarise the data on the effect of a comprehensive geriatric assessment or geriatric assessment with intervention on cancer care, treatment completion, adverse effects, GA domains and survival	mean or median age of study participants ≥ 65	NR	Heterogenous; Stage NR; Systemic therapy	10 (10)	i) Effect on cancer care received ii) Treatment completion iii) Adverse treatment effects iv) Survival v) Health-related quality of life	• CGA prompted less intensive treatment and improved health related quality of life scores in 4/5 studies • CGA increased treatment completion in 3/9 studies • CGA lower rate of grade 3 + chemotherapy toxicity in 2/6 studies • CGA lead to increased supportive care interventions
Ng (2024) [42]	Y	To evaluate if CGA-guided care improves health related quality of life for older adults with cancer compared to standard care	≥ 60 years	Patients: mean age range 71–78 years	Heterogeneous; NR; NR	8 (9)	i) Health-related quality of life	• Variable effects, however positive trend towards improvement at 3 months, • RCTs with larger sample size and CGA conducted prior to treatment demonstrate statistically significant improvement in health-related quality of life for CGA intervention group

GA geriatric assessment, CGA comprehensive geriatric assessment, ADL activities of daily living, IADL independent activities of daily living, RCT randomised controlled trials, CIRS-G cumulative illness rating scale – geriatrics, CCI Charlson comorbidity index, MNA mini nutritional assessment, BMI body mass index, R-MCI revised myeloma comorbidity index, HCT CI Hematopoietic stem-cell transplantation comorbidity index, KFI Kaplan-Feinstein Index, GDS geriatric depression scale, HR hazard risk, CI confidence interval, OR odds risk, NR not reported, RCT randomised controlled trials, VES-13 vulnerable elders survey