Palliative Medicine in Practice · Published 2026-01-30 · DOI 10.5603/pmp.111280
BACKGROUND: Population aging has led to a sustained rise in gastrointestinal cancers among older adults, a group characterized by multimorbidity, frailty, and marked functional heterogeneity. In this setting, decisions based solely on chronological age or tumor stage risks resulting in both overtreatment and undertreatment. METHODS: We conducted a structured narrative review of the literature to synthesize current evidence on the role of comprehensive geriatric assessment (CGA) in clinical decision-making among older adults with gastrointestinal cancer. Relevant primary studies, systematic reviews, and clinical practice guidelines were identified through database searches and analyzed thematically. Findings were integrated with interdisciplinary clinical expertise to inform the development of an evidence-informed conceptual framework. RESULTS: The review synthesized evidence from clinical and observational studies, geriatric oncology research, and palliative care literature addressing decision-making in older adults with gastrointestinal cancer. CGA identifies clinically relevant vulnerabilities, stratifies the risk of treatment-related toxicity and functional decline, and guides optimization strategies before and during cancer treatment. Integrated with geriatric oncology and palliative care principles, CGA supports proportional, person-centered decisions that align with prognosis, symptom burden, and individual goals of care. CONCLUSIONS: We propose the palliative oncogeriatric assessment (POGA) as an evidence-informed, integrative conceptual framework that builds on CGA and is supported by a stepwise screening approach to facilitate implementation and strengthen individualized and proportionate decision-making for older adults with gastrointestinal cancer.
Abstract from DOAJ. Public domain (CC0 1.0).
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