2417 - Geriatric Assessment among Vulnerable Older Adults Undergoing Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer

Purpose/Objective(s): Guidelines suggest older adults with cancer should undergo pre-treatment screening with the G8 or Vulnerable Elders Survey-13 [VES-13] for geriatric vulnerability, a measure of overall health and function. For those who screen positive, geriatrician-led comprehensive geriatric assessment (CGA) is recommended given demonstrated benefits in quality-of-life, physical function, and treatment tolerability. Despite this, whether geriatric evaluations occur in high-risk radiation oncology settings remains unclear. Therefore, we sought to characterize patterns of geriatric screening, CGA, and geriatrician engagement among vulnerable older adults undergoing stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC).

Materials/Methods: We reviewed the records of vulnerable (retrospectively calculated G8 score =14) patients aged =65 with early-stage NSCLC who completed SBRT 01/01/17-12/31/22, abstracting demographic and clinical history. Using a structured keyword search, we determined rates of 1) geriatric screening (G8 or VES-13), 2) CGA assessment, and 3) geriatrician visits for any reason, both peri-SBRT (in the six weeks pre- and post- consultation), and for the time between diagnosis and death or last follow-up. Descriptive statistics were used to summarize findings.

Results: Overall, 291 vulnerable patients with early-stage NSCLC completed SBRT (median age 79.3 years, 62.9% female). At SBRT start, many had functional limitations (median ECOG 1, IQR 1-2), multimorbidity (median CCI 7, IQR 6-9), polypharmacy (=5 daily prescriptions, 83.5%), documented dementia or depression (37.1%), and elevated falls risk (27.2%). Despite this, no patients completed peri-SBRT vulnerability screening and only 3 (1.0%) completed CGA, none through referral from radiation oncology. From diagnosis to death or last follow-up, only 1 additional patient completed geriatric screening and 8 (2.7%) additionally completed CGA.

Conclusion: Recommended geriatric evaluations occur infrequently in vulnerable older adults undergoing SBRT for NSCLC. As many of these patients may predominantly interface with radiation oncologists for cancer care, incorporation of geriatric screening and CGA into high-risk radiation oncology settings is needed.