Feasibility and implementation of remote geriatric assessment–guided supportive care (GAIN-S) in public oncology settings.

Abstract

1582 Background: The ASCO Global Guideline recommends routine geriatric assessment (GA) for adults aged ≥65 years with cancer to identify vulnerabilities beyond standard oncology evaluation and guide tailored management. However, real-world implementation of GA-guided interventions in low-resource settings remains limited. Building on prior feasibility work in private (PRI) oncology settings, we evaluated the feasibility and implementation of a remote, multidisciplinary GA-guided intervention in public (PUB) oncology settings in Brazil. Methods: We conducted a prospective feasibility and implementation study in PUB settings, with contextual reference to prior PRI experience. Patients aged ≥65 years initiating chemotherapy underwent baseline GA assessing functional status, depressive symptoms (GDS), cognitive screening (Mini-Cog), chemotherapy toxicity risk (CARG), nutritional status, and quality of life (FACT-G), with repeat assessment at 12 weeks. Identified impairments prompted referral to telehealth interventions (geriatrics, nutrition, psychology/psychiatry, exercise). Feasibility outcomes included recruitment, GA completion, referral recommendations, and follow-up retention. Implementation barriers in PUB settings were prospectively documented. Results: A total of 109 patients were included (PRI n=61; PUB n=48). The PUB cohort was younger (mean age 72 vs 76), included a higher proportion of Black participants (58% vs 44%), had lower education (no/limited 19% and elementary school 50% vs college degree 47%), and more advanced disease (92% stage III-IV vs 54% stage IV). Baseline geriatric vulnerability was similar (median CARG 6 vs 7, GDS 2); weight loss was more frequent in PUB (54% vs 36%). Quality of life was lower in PUB (FACT-G -5 points). GA identified actionable vulnerabilities, with 21% referred to ≥1 specialist (vs 33% in PRI) and 44% to ≥2 specialists (vs 28% in PRI). Key challenges included delayed recruitment, limited digital literacy (63%), restricted videoconferencing (73%), delays in nutritional supplements (38%), and exercise adaptation (50%), prompting ongoing, context-specific adaptations. Conclusions: Remote GA delivery and identification of actionable vulnerabilities were feasible in PUB settings in Brazil. Similar geriatric vulnerability profiles and characterization of implementation barriers support the scalability of GA-guided care in low-resource settings. Clinical trial information: NCT07084454 .