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Comprehensive geriatric assessment modifies treatment plans and associates with survival in older adults with gastrointestinal malignanciesDoes a pre-surgery check-up actually change treatment plans and help older adults with cancer live longer?

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Key Takeaway
Consider integrating CGA into preoperative workflows for older adults with gastrointestinal malignancies to support individualized decision-making.

This retrospective cohort study included 273 adults aged ≥65 years referred for preoperative comprehensive geriatric assessment (CGA) within a dedicated geriatric surgery clinic at a large academic center. The population consisted of patients with gastrointestinal malignancies. The primary outcomes assessed were modification of the initial treatment plan and overall survival. No comparator group was reported in the study design.

Regarding the modification of the initial treatment plan, 21% of patients overall experienced a change. When stratified by frailty severity, modification rates were 10% for non-frail patients, 31% for those with mild to moderate frailty, and 65% for those with severe frailty. The study found that CGA-derived recommendations were independently associated with overall survival. Specific effect sizes, absolute numbers for survival, or p-values were not reported in the provided data.

Safety and tolerability data, including adverse events, serious adverse events, or discontinuations, were not reported. A key limitation noted is that the influence of treatment planning and survival in surgical oncology remains incompletely defined. The study does not establish causality between CGA and improved outcomes, as it is an observational design. Practice relevance suggests that integrating CGA into preoperative surgical oncology workflows may support individualized, goal-concordant decision-making and help avoid potentially non-beneficial surgery in older adults with cancer.

Imagine standing in a clinic before a major surgery for cancer. Your doctor has a plan, but is it the right one for your specific age and health? A new look-back study examined exactly this question for adults aged 65 and older referred to a specialized geriatric surgery clinic. The team reviewed 273 patients to see if a comprehensive geriatric assessment, or CGA, made a difference. This assessment looks closely at your overall health, not just your cancer, to guide care.

The study found that the assessment changed the initial treatment plan for 21% of patients. The impact was even clearer when looking at frailty. If a patient had no frailty, only 10% of plans changed. But for those with severe frailty, 65% of plans were modified. More importantly, the recommendations derived from this assessment were independently associated with better overall survival. This means patients who received these tailored suggestions tended to live longer.

However, we must be careful with what this tells us. This was a retrospective cohort study, meaning researchers looked at data that already existed. The study admits that how treatment planning and survival work in surgical oncology is still not fully defined. While the practice relevance suggests integrating this check-up helps avoid non-beneficial surgery and supports better decisions, we cannot claim it directly caused the survival benefit yet. The evidence is promising but needs more time to be fully understood.

What this means for you:
A pre-surgery health check changed plans for many older cancer patients and was linked to better survival, though more research is needed.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
Frailty is a major determinant of postoperative morbidity, functional decline, and survival in older adults with cancer, yet it is not consistently integrated into oncologic surgical decision-making. Comprehensive geriatric assessment (CGA) provides a multidimensional evaluation of physiological reserve, functional status, and patient priorities; but, its influence on treatment planning and survival in surgical oncology remains incompletely defined. We conducted a retrospective cohort study of adults aged ≥65 years referred for preoperative CGA between 2020 and 2023 at a dedicated geriatric surgery clinic within a large academic center. Patients were stratified by frailty status and CGA-derived clinical recommendation: Fit for Treatment, Prehabilitation & Surgery, or Other Intervention. Primary outcomes were modification of the initial treatment plan and overall survival. Associations were evaluated using multivariable logistic regression and Cox proportional hazards models. Among 273 patients (median age 82 years; 42% female), treatment plans were modified in 21%, with modification rates increasing by frailty severity (non-frail 10%, mild–moderate 31%, severe 65%; p CGA-derived recommendations substantially influenced surgical oncology treatment selection and were independently associated with survival, providing prognostic information beyond frailty status alone. Integrating CGA into preoperative surgical oncology workflows may support individualized, goal-concordant decision-making and help avoid potentially non-beneficial surgery in older adults with cancer.
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