Reaching higher ground: Expanding access to geriatric oncology services in underserved Mountain West communities.

110 Background: Comprehensive Geriatric Assessment (CGA) is recommended for older adults with cancer, yet its adoption in routine oncologic care remains limited. This is largely due to the lack of integrated geriatric services within oncology practices, especially in rural and resource-constrained settings. The Huntsman Cancer Institute (HCI) is an NCI designated cancer center in the Mountain West whose catchment area includes 5 states, 10 million residents and 17% of the continental US landmass, making it the largest geographic area served by any NCI designated Comprehensive cancer center. Our study summarizes the adoption of a geriatric oncology service--Geriatric Oncology Assessment and Plan (GOAL) Clinic at HCI. Methods: The GOAL clinic functions as an integrated consultative service, accepting referrals based on age, geriatric syndromes, or comorbidities. It is led by a geriatrics-trained oncology physician and nurse practitioner. A prospective registry was developed to track demographics, visit details, CGA results, and referrals. The creation of registry and analysis was approved by the institutional IRB. Results: From 2020-2025, 391 unique patients with solid and hematological malignancies were seen. Most patients were from Utah (93%), and 26% were from rural counties. 92% of evaluations were done in person and most patients had more than one visit. Patients were predominantly white (87%), female (55%) and Medicare-insured (87%), overweight or obese ( > 66%) with a median age of 78 years. About 71% had ECOG PS ≤2 and 74% had low-risk scores (0-1) on the Malnutrition Screening Tool. Over 40% of patients had a PHQ9 score of 5 or higher and 10% had GAD7 of 10 or higher, consistent with greater than mild to moderate anxiety and depression. The most common referrals made by the clinic for patients focused on cognitive evaluation (speech therapy, neuro-cognitive aging programs), mood disorder management (psychiatry, social work) and management of non-cancer related comorbidities (subspecialty referrals). Conclusions: The GOAL clinic offers a scalable model for integrating geriatrics into oncology care in underserved regions of the Mountain West. Most patients were functional older adults with complex needs. Overweight and obesity were more common than malnutrition, underscoring the need for personalized nutrition and physical activity interventions. Future analyses will assess the clinic’s impact on healthcare utilization and cancer outcomes. GOAL patient characteristics (2020-2025). Overall Age 61-70 17% 71-80 48% 81-90 29% > 90 5% ECOG PS ≤ 2 71.7% Race/Ethnicity White 87.0% Hispanic 7.4% State of Residence Non-UT resident 7.0% Utah residents Salt Lake County 59% Other UT counties 26% Mean BMI 26.6 Advance directive 65% PCP on file 83% Mini Cog Score 0-2 (positive screen) 10% MOCA < 25 (abnormal screen) 25% GAD-7 (≥10) 10.8% PHQ-9 (≥5) 40.7% Malnutrition Screening Tool (MST) ≥2 14%