Zacharoula Sidiropoulou: Treatment Tailoring is not Ageism – It is Good Medicine – Oncodaily

Report on Comprehensive Geriatric Assessment in Oncology and Alignment with Sustainable Development Goals

1.0 Introduction

This report analyzes the critical role of Comprehensive Geriatric Assessment (CGA) in oncology for older adults, as highlighted in a case study presented by Dr. Zacharoula Sidiropoulou. The analysis underscores the urgent need to integrate geriatric principles into cancer care to meet global health commitments, particularly Sustainable Development Goal 3 (Good Health and Well-being) and Sustainable Development Goal 10 (Reduced Inequalities). The failure to provide specialized assessment for older patients represents a significant gap in delivering equitable, effective, and person-centered healthcare.

2.0 Case Study Analysis: An 80+ Year-Old Patient with Metastatic Breast Cancer

The case concerns an 80+ year-old woman, previously autonomous, diagnosed with bone metastases from breast cancer. Following the initiation of systemic treatment, her health rapidly deteriorated, leading to death within two months. This outcome raises critical questions about the adequacy of her initial assessment.

2.1 Unaddressed Vulnerabilities and Health Inequities

The patient presented with multiple underlying conditions that were not formally evaluated through a CGA. This oversight directly contravenes the principles of SDG 10 by failing to account for age-related vulnerabilities.

• Comorbidities: Congestive heart failure, chronic kidney disease, atrial fibrillation, and osteoporosis.
• Assessment Gap: A standard Performance Status assessment was conducted, which is known to miss over 50% of geriatric vulnerabilities.
• Consequence: The patient’s rapid decline was likely influenced by a combination of treatment toxicity, unrecognized frailty, and aggressive disease biology, factors a CGA is designed to identify and mitigate.

3.0 The Role of Comprehensive Geriatric Assessment (CGA) in Achieving SDG 3

CGA is an evidence-based, multidisciplinary evaluation that provides a holistic view of an older person’s health. Its implementation is fundamental to achieving SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

3.1 Key Benefits of CGA

1. Predicts Treatment Tolerance: More accurately predicts toxicity and adverse outcomes than standard clinical judgment or chronological age.
2. Reduces Complications: Guides therapy adjustments that reduce severe complications, emergency visits, and hospitalizations, thereby promoting patient well-being.
3. Personalizes Care: Enables treatment tailoring based on physiological reserve, cognitive function, and nutritional status, ensuring care is appropriate and effective.
4. Aligns with Patient Values: Incorporates patient goals and social support structures into the treatment plan, ensuring care is respectful and person-centered.

By personalizing treatment, CGA directly supports the reduction of premature mortality from non-communicable diseases (Target 3.4) and enhances the quality of essential health-care services (Target 3.8).

4.0 Systemic Barriers and Recommendations for Institutional Strengthening (SDG 16)

Despite international recommendations, the real-world implementation of CGA in oncology remains below 30%. This gap highlights a systemic failure within healthcare institutions to provide effective and inclusive care, a challenge addressed by SDG 16 (Peace, Justice and Strong Institutions).

4.1 Recommendations for Action

• Integrate Geriatric-Oncology Programs: Healthcare systems must formally recognize and fund geriatric-oncology programs as a standard of high-value care. This institutional reform is essential for building effective and accountable health systems.
• Mandate Comprehensive Assessment: Every older cancer patient deserves a complete assessment that extends beyond tumor biology to include functional reserve, comorbidity burden, and cognitive status.
• Advance Precision Geriatrics: As precision oncology advances, it must be paralleled by precision geriatrics to ensure treatment strategies are truly individualized.

Tailoring treatment based on a comprehensive assessment is not ageism; it is a cornerstone of good medicine and a prerequisite for achieving health equity. The predictable and often modifiable nature of rapid decline in older patients necessitates proactive, specialized care. This approach is not about providing less treatment, but about providing the right treatment for every individual, thereby upholding the core SDG principle of leaving no one behind.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s central theme is improving health outcomes for a specific patient group—older adults with cancer. It discusses the diagnosis, treatment, and management of a non-communicable disease (cancer), advocating for better assessment and care to prevent severe complications, reduce hospitalizations, and avoid rapid deterioration and death.

SDG 10: Reduced Inequalities

• The article directly addresses inequality in healthcare based on age. It argues that older patients are often not given a Comprehensive Geriatric Assessment (CGA), leading to poorer outcomes. The statement, “Treatment tailoring is not ageism—it is good medicine,” explicitly frames the issue as one of providing equitable, appropriate care to an older demographic, ensuring their specific vulnerabilities are not overlooked.

SDG 9: Industry, Innovation, and Infrastructure

• The article calls for advancements in medical science and practice. The plea that “As precision oncology advances, precision geriatrics must advance with it” is a direct call to enhance scientific research and innovation, specifically in the field of geriatric care, to support the health of an aging population.

SDG 16: Peace, Justice, and Strong Institutions

• The article advocates for systemic changes within healthcare institutions. The call to establish and recognize “geriatric-oncology programs as high-value care” and to implement “multidisciplinary decision-making” points to the need for developing more effective, accountable, and inclusive healthcare institutions that can cater to the complex needs of all patients.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.4: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” The article focuses on improving cancer treatment for older adults to prevent “rapid deterioration and death” and mitigate “severe complications” from treatment, directly contributing to reducing mortality from a non-communicable disease.
• Target 3.8: “Achieve universal health coverage, including… access to quality essential health-care services…” The article’s core argument is for universal access to a specific quality healthcare service—the Comprehensive Geriatric Assessment (CGA)—for all older cancer patients, stating that “every older cancer patient deserves complete assessment, individualized treatment, and proactive supportive care.”

SDG 10: Reduced Inequalities

• Target 10.2: “By 2030, empower and promote the social… inclusion of all, irrespective of age…” The article advocates for the inclusion of older adults in personalized and effective cancer care by tailoring treatment to their “physiological, not chronological, age,” thereby combating age-based disparities in medical treatment.
• Target 10.3: “Ensure equal opportunity and reduce inequalities of outcome…” The article highlights that the lack of CGA for older patients leads to unequal, and often worse, health outcomes. By advocating for its implementation, it seeks to ensure older adults have an equal opportunity for successful treatment and better quality of life.

SDG 9: Industry, Innovation, and Infrastructure

• Target 9.5: “Enhance scientific research, upgrade the technological capabilities of industrial sectors in all countries… encouraging innovation…” The call for “precision geriatrics” to advance in parallel with “precision oncology” is a direct appeal to enhance scientific research and innovate within the medical field to develop better diagnostic and treatment strategies for older patients.

SDG 16: Peace, Justice, and Strong Institutions

• Target 16.6: “Develop effective, accountable and transparent institutions at all levels.” The demand for “geriatric-oncology programs” and standardized multidisciplinary decision-making is about building more effective and accountable healthcare systems and institutions capable of delivering specialized, high-value care.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for SDG 3

• Mentioned Indicator: The implementation rate of Comprehensive Geriatric Assessment (CGA). The article provides a direct metric: “Despite international recommendations, real-world implementation remains
• Implied Indicators: The article implies that using CGA would lead to measurable improvements, which can serve as indicators for Target 3.4. These include:
  • Rates of severe treatment complications/toxicity.
  • Frequency of emergency visits and hospitalizations among older cancer patients.
  • Mortality rates for older cancer patients undergoing systemic treatment.

Indicators for SDG 10

• Implied Indicator: The proportion of older cancer patients (e.g., 70+) who receive a CGA as part of their treatment planning. An increase from the current sub-30% level would indicate a reduction in age-based inequality in care (Targets 10.2 and 10.3).

Indicators for SDG 9

• Implied Indicator: The volume of research, publications, and funding dedicated to “precision geriatrics” and geriatric-oncology. This would measure progress towards enhancing scientific research as called for in Target 9.5.

Indicators for SDG 16

• Implied Indicator: The number of established and recognized “geriatric-oncology programs” within healthcare systems. This would measure the development of more effective institutions as per Target 16.6.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

Source: oncodaily.com