Measuring functional status of older adults with cancer with patient and performance-based measures, a how-to guide: A young society of geriatric oncology and nursing and allied health initiative

Functional status is an indicator of quality of life, cancer-related outcomes, chemotherapy toxicity, increased health care use, and even mortality [ 1 Van Cleave J.H. Smith-Howell E. Naylor M.D. Achieving a high-quality cancer care delivery system for older adults: innovative models of care. Semin Oncol Nurs. 2016; 32: 122-133 Crossref PubMed Scopus (6) Google Scholar , 2 Hurria A. Togawa K. Mohile S.G. et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011; 29: 3457 Crossref PubMed Scopus (1064) Google Scholar , 3 Extermann M. Boler I. Reich R.R. et al. Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer. 2012; 118: 3377-3386 Crossref PubMed Scopus (678) Google Scholar , 4 Pergolotti M. Deal A.M. Williams G.R. et al. Activities, function, and health-related quality of life (HRQOL) of older adults with cancer. J Geriat Oncol. 2017; 8: 249-254 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar ]. Measurement of functional status, is strongly recommended by The International Society of Geriatric Oncology (SIOG) and the American Society of Clinical Oncology (ASCO) as a core domain of the geriatric assessment (GA) [ [5] Mohile S.G. Dale W. Somerfield M.R. et al. Practical assessment and Management of Vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. J Clin Oncol. 2018; 36: 2326-2347 Crossref PubMed Scopus (452) Google Scholar ] to optimize treatment, and to inform interventions and supportive care for older adults with cancer [ [6] Magnuson A. Lemelman T. Pandya C. et al. Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study. Support Care Cancer. 2018; 26: 605-613 Crossref PubMed Scopus (30) Google Scholar , [7] Kenis C. Heeren P. Decoster L. et al. 83 implementation of geriatric assessment in older cancer patients: a survey on treating physicians' general experiences and expectations. Eur J Oncol Nurs. 2014; 18: S24-S25 Abstract Full Text PDF Google Scholar ]. Performance status, historically measured by crude measures such as Karnofsky Performance Status and Eastern Cooperative Oncology Group (ECOG), are not sensitive or specific enough for patient-centered, precision-based care [ [8] Jolly T.A. Deal A.M. Nyrop K.A. et al. Geriatric assessment-identified deficits in older cancer patients with normal performance status. Oncologist. 2015; 20: 379-385 Crossref PubMed Scopus (120) Google Scholar ]. Recommended assessment of functional status is a combination of patient- or proxy-reported and physical performance-based measures [ [9] Sattar S. Alibhai S.M. Wildiers H. Puts M.T. How to implement a geriatric assessment in your clinical practice. Oncologist. 2014; 19: 1056 Crossref PubMed Scopus (44) Google Scholar ]. This paper provides the "how-to" guide to implement both forms of measurement.