Outcomes of mortality and health care utilization in frail older patients with cancer receiving target therapies and/or immunotherapy.

1662 Background: ASCO & NCCN guidelines recommend geriatric assessment for cancer patients aged 65+ to identify vulnerabilities missed on standard evaluations. Patients with G8 ≤14 (High risk) are potentially frail and at risk for chemotherapy toxicity, early mortality and ED visits/hospitalizations. However, there is currently limited evidence regarding the impact of a high-risk G8 score on outcomes among older frail patients receiving immunotherapy or targeted therapies. Methods: G8 screening was done at initial oncology consultation. Data was analyzed for individuals aged 65 and above referred between January 2021 and December 2024. Outcomes were measured 180 days after referral. A chi-square test assessed the relationship between demographic or outcome variables and G8 score. Multivariate regression and survival models predicted outcomes using age, sex, ethnicity, cancer type, and risk score. Results: This study included 1,671 patients receiving targeted therapy and/or immunotherapy. Participants ranged in age from 65 to 102 (median 75). Higher risk scores were linked to lower BMI (underweight: 92%, healthy: 74%, overweight/obese: 57%, p < .0001), older age (p < .0001), and female sex (73% vs 62%, p < .0001). Ethnicity was not related to risk scores. High risk patients receiving target and/or immunotherapy had over 3x higher mortality rates at 180 days than low risk ones (p <0.0001). They were also 1.4x as likely to have an ED Visit or hospitalization, 2x as likely to be referred to palliative care, and 5x as likely to be referred to hospice (p < 0.0001). Multivariate analysis showed patients with upper GI and thoracic cancers were 1.4x more likely to be admitted and had over 2.7x mortality rate compared to those with breast cancer (p < .0001 - 0.0188). A total of 515 patients underwent only immunotherapy. Outcome trends and the association between risk score and demographics were similar to the combined target therapy and/or immunotherapy study. Conclusions: A high-risk G8 score (≤14) is linked to higher mortality and more emergency visits or hospitalizations in older cancer patients receiving immunotherapy or targeted therapies. It is recommended that oncologists integrate geriatric assessment results into treatment decisions involving immunotherapy and targeted therapies. Outcomes of patients by risk score and treatment type 180 days after referral. Risk Score/Treatment Type Mortality ED Visits orHospitalizations Palliative Care Referral Hospice Referral High risk G8-Combined target/Immunotherapy 15.3% 51.1% 33.0% 12.1% Low risk G8 - Combined Target/Immunotherapy 3.7% 29.2% 14.8% 2.3% p-value <0.0001 <0.0001 <0.0001 <0.0001 High risk G8 - Immunotherapy alone 26.5% 61.5% 40.1% 22.3% Low risk G8 - Immunotherapy alone 8.7% 43.5% 19.6% 5.1% p-value <0.0001 0.001 <0.0001 <0.0001