The comprehensive geriatric assessment (CGA) is a "multidimensional, interdisciplinary diagnostic process focusing on determining an older person's medical, psychosocial, and functional capabilities to develop a coordinated and integrated plan for treatment and long-term follow-up" (Wildiers et al., 2014). CGA domains usually include function, comorbidity (including polypharmacy), falls, depression, cognition, and nutrition (Mohile et al., 2018). Various outcome measures can be used to tailor the assessment to the patient's needs. CGA is a widely accepted tool to ensure efficient and timely healthcare practices (DuMontier et al., 2020), but use of CGA principles by rehabilitation therapists caring for people with cancer in their homes has not been investigated. The column discusses the application of CGA principles for rehabilitation therapists in home care to improve patient management and coordination of care for patients with cancer.

The National Comprehensive Cancer Network, European Organization for Research and Treatment of Cancer, and the International Society of Geriatric Oncology recommend a CGA-based approach for patients with cancer to detect unrecognized health problems that could interfere with cancer treatment and/or cause death unrelated to cancer (Pilotto et al., 2016). The CGA is a useful tool to identify vulnerabilities that are otherwise not captured in routine oncology assessments (Mohile et al., 2018). A CGA approach in management of older cancer survivors can help select the most appropriate therapy, thereby improving patient outcomes and promoting patient-centered decision making and communication between patients and oncologists. It can also reduce over- or undertreatment, improve cancer treatment tolerance and completion, and predict the frequency of long-term care and hospitalizations (Zuccarino et al., 2022). There is evidence that the cost of providing timely, appropriate services is offset by reduced use of unwarranted, expensive institutional services (Zuccarino et al., 2022).

Although most of the literature focuses on health outcomes of CGA in inpatient settings, there is evidence that home programs with CGA-based interventions are effective in reducing functional decline and overall mortality as well as improving chemotherapy tolerance (Pilotto et al., 2016). Barriers of conducting a home-based CGA include challenges in communication between staff conducting the CGA, poor patient acceptance of preventative services, and challenges in operationalizing CGAs (Sum et al., 2022). On the other hand, a home-based CGA can allow for direct observation of performance and provide important information on living environments and daily function to support a more detailed and accurate assessment. Once implemented, the home-based CGA can improve timely coordination of care to meet unaddressed needs and reduce the need for clinic visits (Sum et al., 2022).

Home-Based CGA with an Oncologic Focus

Recent trends in oncology care have shown a shift to the home setting (Nipp et al., 2022). Handley and Bekelman (2019) discussed the feasibility and benefits of an oncology Hospital at Home program to achieve equal or higher-quality cancer care and better patient satisfaction at less cost than acute care. There will likely be a demand for rehabilitation services for these complex patients, requiring an approach such as the CGA to coordinate and deliver care. Administering and coordinating a CGA in the home for patients with cancer is within the scope of practice of rehabilitation therapists and many of the domains are already evaluated by home care rehabilitation therapists.

As the CGA is comprehensive and takes extended time to complete, preliminary screening can be used to determine if a more thorough CGA is required (Overcash et al., 2019). Administering a prescreening instrument can save time and target those who would benefit. These assessments include the Geriatric-8 and the Vulnerable Elders Survey-13 health status screening tools or an abbreviated CGA (including issues regarding activities of daily living, cognition, and depression).

The Geriatric Depression Scale is important to detect and manage depression for better cancer treatment outcomes and for improvement to adherence to recommendations. The Mini-cog is a quick screening tool for cognitive limitations. The Timed Up and Go is a valid tool to screen for fall risk and guide future rehabilitation interventions such as lower body strength, balance, providing fall education, and proactive planning in the event of a future fall (Overcash et al., 2019). See the Table for a summary of recommended outcome measures and assessments for home-based oncology CGA.

Table: Recommended Outcome Measures/Assessments for Home-Based Oncology CGAa

The Future of the Home-Based CGA for Patients with Cancer

The CGA was originally intended for older adults; however, there are many young patients with complex oncological histories who would benefit from a multifaceted comprehensive assessment, however, more research is warranted. As many people with cancer have extended, complex disease journeys, more research is needed regarding when and how to administer a CGA in the homecare setting. To fully leverage the CGA findings from the rehabilitation therapist, steps must be taken to facilitate communication with interdisciplinary team members, including the patient's oncologists. Rehabilitation therapists have the skills and often develop long-term relationships with patients with cancer and are well positioned to provide comprehensive, holistic assessments and interventions to optimize outcomes in the home setting through a CGA-based approach.

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