Conference Abstracts - Summit on Cancer Health Disparities (SCHD25)
Vol. 5, Issue Supplement 1, 2025 · S1-2
Using Virtual Interdisciplinary Geriatric Oncology Review (VIGOR) Rounds to Identify Interventions for High-risk Older Adults with Cancer
Kevin Chang, MD, MS,Tiffany Thein, BS,Carnie M. Lewis, OTD, OTR/L,Charis Stewart, RN,Alexis Coulorides Kogan, PhD,Steven R. Grossman, MD, PhD,Diana Hanna, MD,Mary Aalto, ,Yasaman Amanat, OTD,Megan Seifert, OTD, OTR/L,Cindy Luff, MA, OTR/L,Stacey Morikawa, OTD, OTR/L,Rachel Lander-Canseco, MS, RD, CDE,Gabriel Wang, PharmD,Jennifer Parga, LCSW,Svetlana Krasilshchik, LCSW ,Susie Nam, MS,Lydia In, PT, DPT, MSPT ,Gerardo Gorospe, RN, BSN, MSN, BMTCN,Mario Lopez, MPA, MSN, RN,Rabia Rehman, M.B.B.S.,Monica Zell, MD,Sandra Algaze, MD
Submission received: 2025-02-15 / Accepted: 2025-02-23 / Published: 2025-04-24
Abstract
Background
Older adults with cancer are a growing and vulnerable population, experiencing worse outcomes due to aging-related vulnerabilities not fully captured by traditional measures like age and performance status. They are also underrepresented in clinical trials, limiting equitable access to novel therapies. Despite evidence-based guidelines and multiple professional societies recommending geriatric assessments, implementation remains variable. We piloted a modified Practical Geriatric Assessment (mPGA) and Virtual Interdisciplinary Geriatric Oncology Review (VIGOR) rounding model to identify interventions for high-risk older adults with cancer and enhance multidisciplinary care delivery.
Methods
Patients aged 70+ presenting to a gastrointestinal oncology clinic at an urban academic cancer center are screened with a mPGA. Our mPGA includes the traditional PGA, a scored assessment of seven aging-related domains from the Cancer and Aging Research Group and American Society of Clinical Oncology, and an institutionally-developed addendum to identify practical needs like safe living situations and transportation access. High-risk patients identified by the mPGA are discussed in pilot VIGOR rounds with representatives from oncology, palliative care, pharmacy, nursing, social work, nutrition, research coordinators, speech, physical, and occupational therapy.
Results
Between 2/2024-12/2024, 57 patients completed mPGAs (mean age 76.8, range 70-95). 25 identified as female. 24 identified as Hispanic, 14 as non-Hispanic white, 11 as Asian, 3 as black, and 5 as other. 20 spoke a primary language other than English. Nearly all (56, 98%) had impairments in at least one of the seven domains assessed by the PGA, while 45 had impairments in three or more. The most commonly impaired domains were physical capability (48, 84%), high burden of comorbidities (46, 81%), and functional status impairments (41, 72%). Only 7 patients had participated in oncologic clinical trials at any point in their course. Among these patients,18 high-risk patients were discussed in VIGOR rounds. Key issues identified include high risk of chemotoxicity, polypharmacy and Beer's criteria medication use, home health and home safety needs, new palliative care referrals, lack of advanced directives, and optimization for clinical trial candidacy.
Conclusion
A two-step model using the mPGA screening and VIGOR rounds is a feasible and impactful model to enhance multidisciplinary care for high-risk older adults with cancer, enabling actionable interventions to mitigate disparities by improving treatment safety and supportive services engagement, and facilitating discussions to ensure that older adults maintain access to clinical trials. Our findings highlight the importance of integrating geriatrics into routine oncology practice to address age-related healthcare disparities in cancer care.