Table 1.

Recommended Geriatric Oncology Tools

Assessment of the below GA domains recommended for all patients aged 65+	Recommended Tool and Score Signifying Impairment	Evidence to Support Recommendation	Administration Characteristics	Considerations and other evaluation options
Function	Instrumental Activities of Daily Living (IADLs): Dependence on any task signifies impairment	Large prospective studies of older patients with cancer show IADLs predict chemotherapy toxicity, mortality, hospitalizations, and functional decline. Advocated by experts in Delphi consensus panels.	PRO; <5 min	Consider Activities of Daily Living (ADLs); Any ADL deficit is utilized for characterization of frailty Consider objective measure of physical performance such as Short Physical Performance Battery; Timed Up and Go; or Gait Speed
Falls	Single item: “How many falls have you had over the last 6 months (or since the last visit)?”; one or more recent falls	Falls are common in older adults with cancer and can lead to serious injury. Falls have been associated with chemotherapy toxicity. Assessment for falls is recommended by geriatric oncology expert panels and the American Geriatrics Society for all older adults	PRO;<1 min
Comorbidity	Robust review of chronic medical conditions and medications through routine history: >3 chronic health problems or >1 serious health problem	Comorbidity is associated with poorer survival, chemotherapy toxicity, mortality, and hospitalizations.	Part of routine history	Consider validated tools such as Cumulative Illness Rating Score-Geriatrics (CIRS-G) or Charlson; history, CIRS-G, OARS comorbidity recommended by experts
Cognition	Mini-Cog; An abnormal test is defined by 0 words recalled OR 1-2 words recalled +abnormal clock drawing test. This a screening test for cognitive impairment and abnormal scores require further follow up and decision making capacity assessment.	Growing data shows cognitive impairment is associated with poorer survival in older patients with cancer and increased chemotherapy toxicity risk. Mini-Cog has been shown to have high sensitivity and specificity for identifying cognitive impairment when compared to longer tools.	Administered; <5 min	Multiple tools are available for cognitive assessment. Blessed Orientation Memory Scale is practical and is included in the Cancer-Specific GA developed by Hurria et al. The Mini Mental State Examination (MMSE) has more robust data for prediction of outcomes in older patients with cancer and has been shown to predict chemotherapy toxicity; it is included in the CRASH tool developed by Extermann et al. The Montreal Cognitive Assessment (MOCA) is also utilized by geriatricians. Both MMSE and MOCA are considerably longer than Mini-Cog and Blessed.
Depression	Geriatric Depression Scale (GDS)-15 item; A score of >5 suggests depression and requires follow-up.	Depression has been associated with unexpected hospitalizations, treatment tolerance, mortality, and functional decline in older adults with cancer receiving chemotherapy; these studies primarily assessed depression with the GDS.	PRO; <5 min	GDS recommended also by ASCO guidelines for depression. The Patient Health Questionnaire-9 is an alternative and is also recommended by ASCO guidelines for depression. The mental health inventory is an option and has been associated with outcomes in older patients with breast cancer.
Nutrition	Unintentional weight loss; >10% weight loss from baseline weight); body mass index < 21 kg/m2	Poor nutrition is associated with mortality in older patients with cancer.	PRO;<1 min	Consider G8 and Mini-Nutritional Assessment as alternatives; both are associated with mortality in older patients with cancer.
The following tools can provide estimates of risk for chemotherapy toxicity	Items	Study Population	Administration Characteristics	Considerations
Cancer and Aging Research Group toxicity tool: provides estimates for overall risk of grade 3-5 chemotherapy toxicity.	11 items; prior falls (1 or more vs none), hearing problems (deaf to excellent), limitations in walking one block (limited a lot, limited a little, not limited), difficulties with taking meds, interference of social activities by physical health and/or emotional problems (all of the time to none of the time) as well as age, height, weight, gender, cancer type (gastrointestinal vs genitourinary vs other), dosage (standard vs dose reduced), number of chemotherapy agents (mono vs poly), hemoglobin level, and creatinine clearance.	Patients aged 65+ with a solid tumor malignancy or lymphoma starting a new chemotherapy regimen (any-line)	PRO/Administered; 5 min Available on-line at: http://www.mycarg.org/(br/)Chemo_Toxicity_Calculator	Can ask geriatric assessment variables as part of history or include as part of PRO assessment
Chemotherapy Risk Assessment Scale for High-age patients (CRASH) tool ; provides estimates separately for risk of grade 3 hematologic and grade 3-4 non-hematologic toxicity	Assessment of risk of hematologic toxicity includes: diastolic blood pressure (>72), Instrumental Activities of Daily Living score (<26), and LDH (>459); Assessment of risk of non-hematologic toxicity includes: ECOG PS, Mini-Mental State Examination (<30), and Mini Nutritional Assessment (<28); Chemotherapy intensity is assessed with MAX2 index.	Patients aged 70+ years with histologically proven cancer who were starting chemotherapy	PRO/Administered; Estimated time to completion is on par with full GA (20-30 minutes) Available online: https://moffitt.org/for-healthcare-providers/clinical-programs-and-services/senior-adult-oncology-program/senior-adult-oncology-program-tools).	The CRASH Scale includes GA measures known also to predict other adverse outcomes such as mortality, functional decline, and hospitalizations: IADLs, MMSE, and MNA.
The following screening tools have been independently associated with adverse outcomes in older patients with cancer receiving chemotherapy.	Items	Study Population and Evidence	Administration characteristics	Considerations
G8	8 items covering appetite, weight loss, neuropsychological problems, BMI, number of medications, patient self rated health, and age; score of > 14 signifies impairment Derived from the Mini-Nutritional Assessment	Several large studies have been conducted that include patients aged 70+, which included patients with both solid and hematologic malignancies starting a new chemotherapy agent. G8 is independently associated with mortality (1 year and 3 years) even when controlling for ECOG PS and stage of cancer.	Administered; 5-10 min	G8 can also be used as a screening tool to identify older patients who need more comprehensive geriatric assessment.
Vulnerable Elders Survey-13	13 items including age, self-rated health, common functional tasks, and ability to complete physical activities Score of >3 is associated with mortality and chemotherapy toxicity in older patients with cancer. A score of >7 has been shown to be associated with functional decline	VES-13 score has been shown to be associated with mortality, chemotherapy toxicity, and functional decline.	Administered or PRO (but errors are common with PRO administration); 5-10 min	VES-13 can also be used as a screening tool to identify older patients who need more comprehensive geriatric assessment
Consider assessment of these domains if resources available	Items	Study Population	Administration characteristics	Considerations
Objective physical performance: Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) or gait speed	SPPB includes 3 tests (balance, chair stands, and gait speed); a score of < 9 associated with increased functional decline, nursing home use, and mortality in community dwelling older adults. TUG measures ability for a patient to get out of chair and walk 3 meters or 10 feet and back; a score of > 12 seconds associated with increased risk of falling.	Low SPPB score associated with increased mortality in older women with gynecologic malignancies. TUG and gait speed have been shown to be associated with early mortality (6 months) in older patients with cancer receiving chemotherapy. SPPB and gait speed associated with functional decline in patients with non-metastatic breast cancer receiving chemotherapy.	All administered; 1-5 min depending on test