Integrating geriatric expertise into multidisciplinary tumour boards for older adults with colorectal cancer: a pragmatic real-world cohort study.

[INTRODUCTION] Geriatric assessment improves clinical decision-making in older adults with cancer, but its systematic implementation remains challenging in routine oncology practice. In many centres, geriatric screening is not consistently performed before multidisciplinary tumour boards (MTBs). Our institution applies a pragmatic model in which an onco-geriatrician participates in all MTBs, enabling early identification of frailty and selective referral for comprehensive geriatric assessment (CGA). We evaluated whether older adults with colorectal cancer managed without formal CGA experienced higher rates of treatment-related complications or mortality.

[MATERIALS AND METHODS] We retrospectively included consecutive patients aged 70 years or older with colorectal cancer discussed at weekly MTBs between 2020 and 2023. Patients were classified into CGA and no-CGA groups. Clinical characteristics, treatments, major postoperative complications (Clavien-Dindo grade ≥ III), severe treatment toxicities (CTCAE grade ≥ 3), treatment interruptions, and unplanned readmissions were collected. Ninety-day mortality and 12-month overall survival were analysed using Kaplan-Meier estimates and log-rank tests.

[RESULTS] Among 170 patients, 83 underwent CGA and 87 did not. Patients in the CGA group were older and had more comorbidities as well as greater functional and social frailty. Rates of major postoperative complications, severe treatment toxicities, treatment interruptions, unplanned readmissions, and 90-day mortality were similar between groups (all p > 0.05). Dose reductions during chemotherapy or chemoradiotherapy were more frequent in the CGA group (87.8% vs 51.0%; p < 0.001). Twelve-month mortality was 25.3% in the CGA group and 14.9% in the no-CGA group. Median overall survival was not reached in either group, and no significant difference was observed between survival curves (log-rank p = 0.12).

[DISCUSSION] In this real-world cohort, older adults managed without formal CGA did not experience higher rates of major complications, treatment-related toxicity, or early mortality than those who underwent CGA, despite greater baseline vulnerability in the latter group. Systematic involvement of an onco-geriatrician in MTBs therefore supported appropriate triage and selective referral without compromising patient safety. Embedding geriatric expertise directly within MTBs may represent a pragmatic and scalable strategy to optimize care for older adults with colorectal cancer, particularly in settings with limited geriatric resources.