Implementation of a cancer-oriented geriatric assessment (COGA) clinic to promote age-friendly cancer care: A type III hybrid implementation–effectiveness method in community practice.

Abstract

TPS1681 Background: Cancer incidence increases with age, and adults aged ≥65 years account for the majority of new cancer diagnoses. Standard oncology assessments often fail to identify age-related vulnerabilities such as frailty, cognitive impairment, and functional decline (Hurria et al., JCO 2011). The American Society of Clinical Oncology (ASCO) recommends routine geriatric assessment–guided management for older adults receiving systemic cancer therapy to inform treatment decisions and reduce treatment-related toxicity (Mohile et al., JCO 2018). In alignment with these goals, we established a Cancer-Oriented Geriatric Assessment (COGA) clinic within an academic cancer center. Methods: We implemented a Type III hybrid implementation–effectiveness design to integrate Cancer-Oriented Geriatric Assessment (COGA) into routine oncology practice using the 5M framework (Mind, Mobility, Medications, Matters Most, and Multicomplexity). The Eleanor N. Dana Cancer Center is part of a large academic health system in Northwest Ohio, serving a predominantly rural and suburban population across Ohio and Southeast Michigan. Eligibility included oncology patients aged ≥65 years with a positive G8 screen (≤14), consistent with ASCO and European Society for Medical Oncology (ESMO) recommendations for comprehensive geriatric assessment. A tiered workflow was implemented on January 15, 2026, in which medical assistants obtained vital signs, performed medication reconciliation, and completed standardized screenings for cognition, mood, and nutrition, followed by a geriatrician-led assessment of frailty, fall risk, mobility, and functional status. The medication domain emphasized deprescribing of potentially inappropriate medications, while the Matters Most domain addressed goals of care, advance directives, and social support. Additional geriatric syndromes—including sensory impairment, sleep disturbances, incontinence, and fatigue—were systematically assessed and managed. Risk stratification was guided by validated tools, including the Cancer and Aging Research Group (CARG) toxicity tool and the Schonberg Index, to estimate non-cancer mortality. Primary implementation outcomes included reach (the proportion of eligible patients receiving COGA), adoption (use of COGA by oncology teams), and fidelity (completion of the core 5M domains as intended). Secondary effectiveness outcomes included patient-centered outcomes and unplanned hospitalizations. This scalable, real-world implementation model enables systematic integration of geriatric assessment into oncology practice, with the potential to improve outcomes for older adults with cancer and support broad dissemination across diverse cancer care settings.