Mohile SG, Mohamed MR, Xu H, et al. - In this study, reduction in cancer therapy-induced serious toxic effects was achieved by implementing a geriatric assessment intervention for older patients with advanced cancer. Integrating geriatric assessment with management into the clinical care of older patients with advanced cancer and ageing-related conditions is therefore recommended.

• A high risk for treatment toxic effects has been observed in older adults with advanced cancer.

• This is a cluster-randomized trial of 718 patients aged 70 years and older [mean age was 77·2 years (SD 5·4)] with incurable solid tumors or lymphoma and at least one impaired geriatric assessment domain who were initiating a new treatment regimen.

• Across the USA, 40 community oncology practice clusters were randomized (1:1) to the intervention (oncologists received a tailored geriatric assessment summary and management recommendations) or usual care (no geriatric assessment summary or management recommendations were offered to oncologists).

• In the intervention group, grade 3–5 toxic effects occurred in a lower proportion of patients relative to the usual care group (263 [71%] of 369 patients; relative risk [RR] 0·74 (95% CI 0·64–0·86; p=0·0001).

• In the intervention group, fewer falls over 3 months (35 [12%] of 298 patients vs 68 [21%] of 329 patients; adjusted RR 0·58) and more medications discontinued (mean adjusted difference 0·14) was evident.