Examqo › Examqo library › Geriatric medicine › Conditions in older adults · IMLE
Cancer care in older adults
Cancer treatment decisions in an older adult rest on physiological rather than chronological age: geriatric assessment (function, cognition, nutrition, comorbidity, medications and support) identifies vulnerabilities, predicts toxicity and allows treatment to be tailored — to avoid both overtreatment and undertreatment.
Why it matters in the exam
The exam presents an older adult with cancer for whom chemotherapy is being considered, and asks for the next step: geriatric assessment — at least function (ADL and IADL), falls, comorbidity, cognition, depression and nutrition — as ASCO recommends for every patient aged 65 or over planned for chemotherapy. Candidates are also asked about a short screening tool (G8, score of 14 or less — abnormal) and toxicity calculators (CARG, CRASH).
Recurring points: more than half of cancer diagnoses are in people aged 65 and over; performance status alone does not identify all vulnerabilities; in the GAP70+ trial interventions based on geriatric assessment reduced severe toxicity (about 51% versus 71%); and the time until treatment helps is weighed against life expectancy and the patient's goals.
Candidates are also asked about practical adjustments: calculating kidney clearance before dosing, reviewing medications for interactions, nutritional support, physiotherapy and falls prevention, social support and transport to treatment, and early palliative care in advanced disease. A "fit" older patient usually receives the full standard treatment.
Another typical case: an 80-year-old woman with early breast cancer who is independent and active — she is treated like a younger woman, with adjustments for her other diseases. By contrast, a frail patient with dementia and advanced cancer — the focus is on quality of life and symptom relief.
Key points
- Physiological age, not chronological.
- Geriatric assessment from age 65 before chemotherapy (ASCO).
- G8 of 14 or less — abnormal.
- Toxicity calculators: CARG, CRASH; GAP70+ — less severe toxicity.
- Weigh life expectancy, time to benefit and preferences.
Summary table
| Step | What is done | Exam point |
|---|---|---|
| Screening | G8 or another short tool | G8 of 14 or less — proceed to full assessment |
| Geriatric assessment | Function, falls, comorbidity, cognition, mood, nutrition, medications, support | Recommended from age 65 before chemotherapy |
| Toxicity prediction | CARG or CRASH calculators | Performance status alone is not enough |
| Tailoring treatment | Dose by kidney clearance, a less toxic regimen, supportive care | GAP70+: less severe toxicity |
| Goals | Life expectancy, time to benefit, preferences | Early palliative care |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Geriatrics, Medical licensing exam (IMLE), Oncology, Internal medicine, Family medicine.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- ASCO guideline — Practical assessment and management of vulnerabilities in older patients receiving chemotherapy, 2018 (updated 2023) — Geriatric assessment and toxicity prediction
- SIOG recommendations on geriatric screening and assessment in older patients with cancer, 2014–2021 — G8 screening tool
- GAP70+ cluster-randomised trial — Geriatric assessment intervention to reduce chemotherapy toxicity, 2021 — Main results
- Geriatrics Review Syllabus (American Geriatrics Society), 11th edition (2022) — Oncology
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.