PS5-09-21: Feasibility of Clinical Nurse-Initiated Geriatric Assessments in Breast Medical Oncology Clinic: A Pilot Program

Abstract Background: The incidence of cancer in older adults is substantially rising and oncologists must be prepared to care for this growing vulnerable population. Geriatric assessment (GA)-guided management (GAM) reduces treatment toxicity and improves quality of life in older patients with cancer, leading to its inclusion in national guidelines. However, GA adoption by oncologists remains low, especially in racial and ethnic minority populations. We conducted a pilot program implementing clinical nurse-administered GAs in older adults with breast cancer, with the goal of improving GA completion, particularly among Spanish-speaking patients by using Spanish-translated GAs. Methods: The study was conducted over a 16-week period in 2025 in three breast medical oncology clinics at an academic health system in New York City. Eligible patients were ≥ 65 years, spoke English or Spanish, and had a new or prior breast cancer diagnosis. Medical oncologists in the study received education on the benefits of GAM in older adults with cancer and tools to facilitate GAM in clinic. In the first 8 weeks (pre-intervention), we captured baseline GA completion rates by oncologists and in the second 8 weeks (post-intervention), a clinical nurse intervention was implemented to administer the GAs. A clinical workflow was adapted whereby eligible patients were offered the G8 Geriatric Screening Tool by a medical assistant and a score of ≤ 14 would trigger ASCO’s comprehensive Practical Geriatric Assessment (PGA). The self-reported section of the PGA (in English or Spanish) was completed by the patient, and the provider section was administered by the oncologist (pre-intervention) or nurse (post-intervention). The results of the GAs were reviewed with the patient, and referrals and treatment recommendations, as applicable, discussed by oncologist (pre-intervention) or clinical nurse (post-intervention). Here, we describe demographics for the overall population and baseline GA completion rates, geriatric vulnerabilities identified, and associated referrals made during the pre-intervention phase. Feasibility of the pre-intervention approach was measured by the number of vulnerabilities identified and referrals triggered. Results: As of June 2025, 106 patients have been included, 56% (N=59) pre-intervention and 44% (N=47) post-intervention. The median age of the overall population was 73 years (range 65-94), 42% (N=45) were White, 25% (N=27) Black, 18% (N=19) Hispanic, 8% (N=8) Asian and remaining 7% (N=7) other/unknown. Eleven percent (N=12) were Spanish speaking. Pre-intervention completion rate for the screening G8 tool was 78% (N=46). Based on the results of the G8, 48% (N=22) of patients were recommended the comprehensive PGA, of whom 73% (N=16) completed it. Geriatric vulnerabilities were identified in 12 patients (75%), with an average of 4.8 vulnerabilities per patient assessed, including poor physical function (N=12), low performance status (N=10), high multimorbidity (N=10), and low social support (N=9). Thirteen referrals were made, most frequently to physical and occupational therapy and social work. Conclusions: To our knowledge, this is the first study designed to evaluate feasibility of a clinical nurse intervention to improve GA completion in breast oncology patients, and the first to utilize a Spanish translation of ASCO’s PGA to facilitate delivery in racial/ethnic minority populations. The high baseline GA completion rates suggest that screening and assessment of geriatric vulnerabilities in high-risk oncology patients are feasible when they are effectively integrated into existing clinical workflow and have garnered staff and provider buy-in. Results evaluating the impact of nurse-initiated GAs on changes in G8 and PGA completion, as well as feasibility of the nurse intervention, are forthcoming. Citation Format: R. Patel, T. Hills, H. Nunez, A. Farhadi, A. Bhardwaj, J. Fasano, N. Hall, K. Facey, S. Lee, R. A. Freedman, F. Ko. Feasibility of Clinical Nurse-Initiated Geriatric Assessments in Breast Medical Oncology Clinic: A Pilot Program [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-09-21.