Embedding Geriatric Oncology in a Community Practice of an Academic Health System: Implementation, Outcomes, and End-of-Life Impact.

Abstract

Older adults represent the majority of patients with cancer, yet structured approaches to address their complex needs remain rare in community oncology. We describe the design, implementation, and early outcomes of a scalable geriatric oncology program embedded in a community practice within an academic health system, emphasizing the role of health informatics and population health tools. At Penn Medicine Princeton Health, we launched a dedicated pathway for patients 65 years and older receiving systemic therapy. The ASCO-endorsed Practical Geriatric Assessment was assigned by default and integrated into workflows via smart forms with automated scoring of impairments and nudges for suggested supportive care referrals based on individual patient care needs. A weekly multidisciplinary care meeting supported coordinated care. We evaluated the first 186 patients completing geriatric assessment (GA) with a follow-up of ≥3 months for impairments, supportive care delivery, and end-of-life outcomes. Among 186 patients (median age 79 years), 71% had incurable disease and 87% received systemic therapy. Despite Eastern Cooperative Oncology Group 0-2 in 90%, GA identified functional impairment in 76%, nutritional risk in 55%, and psychosocial concerns in over one third. The program generated 546 referrals (median three per patient); 51% completed advance directives. Among 53 deaths, 81% enrolled in hospice (median 17 days); only 4% received chemotherapy in the last 14 days of life. Geriatric navigation was associated with a 3.4-fold longer hospice stay (<i>P</i> = .002), and prioritization of quality of life with a 2.6-fold longer stay (<i>P</i> = .007). Embedding GA into electronic health record workflows using default logic and team-based care enabled high-fidelity implementation in a resource-constrained setting. This approach identified unrecognized vulnerabilities, facilitated timely supportive care, and aligned treatment with patient values, demonstrating a replicable model to bridge the geriatric oncology implementation gap.