e13768 Background: National guidelines recommend that older patients undergo geriatric screening, G8 and CARG. In our initial six-month pilot at Northern California oncology clinics, high risk (G8 ≤14) and CARG (10-19) scores correlated with higher mortality and ER/IP admission in older adults with newly diagnosed cancer. We then extended this workflow to all Kaiser Northern California clinics. Methods: Patients 65 and above with new cancer diagnoses (Jan 2021–Dec 2024) completed G8 and CARG assessments. Monitored outcomes were ER/IP admissions and mortality. Associations between risk categories and demographics/utilization were tested using chi-square, while Cox models analyzed relationships between scores and time to ER/hospitalization or death. Results: A total of 2,684 patients completed G8, and 4,347 patients completed CARG. The proportion of patients classified as high risk by G8 or CARG increased with each decade of age (G8: < 70 years, 64%; 70–79 years, 65%; 80–89 years, 87%; ≥90 years, 100%; p < 0.0001; CARG: < 70 years, 13%; 70–79 years, 33%; 80–89 years, 53%; ≥90 years, 71%; p < 0.0001). High-risk CARG was more prevalent among men compared to women (33% vs. 29%, p < 0.0001). There was no significant association between ethnicity and high risk G8 or CARG. High risk CARG scores were noted in upper GI (42%), genitourinary (GU) (42%), and lower GI (43%) cancers patients. High risk G8 scores were prevalent in upper GI (85%), thoracic (70%), malignant hematologic (69%), and lower GI (66%) cancers. Both assessment tools demonstrated statistically significant differences among cancer types (p < 0.0001). The rates of mortality, ER/IP admission, and referral to hospice or palliative care increased at 180 days in both high risk G8 and CARG groups (p < 0.0001). Patients with high risk G8 or CARG scores had 3x the mortality rate, 1.4x the ER/IP admission rate, and over 2x as likely to be referred to palliative care or hospice compared to low risk patients. Conclusions: Our follow up analysis with an expanded sample size corroborates previous results, demonstrating that high risk scores on G8 and CARG assessments at initial cancer diagnosis are predictive of ER/IP admissions and mortality in older adults with cancer. These assessments should be incorporated into the initial oncology evaluation to inform shared treatment decision making. Hazard ratios for ER/IP admission and mortality comparing high/low risk G8 and CARG patients. Outcome HR 95% CI p-value High vs Low Risk CARG ER/IP 1.409 1.231- 1.613 <.0001 High vs Low Risk G8 ER/IP 1.332 1.201- 1.478 <.0001 High vs Low Risk CARG Mortality 2.208 1.761-2.769 <.0001 High vs Low Risk G8 Mortality 1.894 1.594-2.25 <.0001 Age, cancer type, and BMI also showed significance in determining outcomes.
Baijal et al. (Thu,) studied this question.