Age-Friendly Oncology Care for Older People in Viet Nam: Building a Coordinated Pathway from Geriatric Assessment to Safer Systemic Cancer Treatment

AGE-FRIENDLY CARE QUALITY · MEASUREMENT, IMPLEMENTATION & LEARNING

Last reviewed: October 2026

Consider a 74-year-old woman in Viet Nam preparing to begin systemic cancer treatment. Her oncologist has reviewed the diagnosis, disease stage, treatment options and relevant laboratory results. She appears reasonably well during the consultation and expresses a clear wish to receive treatment. Yet a few additional questions reveal concerns that have not been fully considered.

She has difficulty walking longer distances, has lost weight in recent months and sometimes struggles to remember which medicines she has taken. Her daughter helps arrange appointments but works full-time and may not always be available when problems arise. The patient wants treatment, but she is particularly worried about losing her independence.

None of these findings necessarily makes systemic cancer treatment inappropriate. They do, however, raise questions about how safely she can receive treatment, whether additional support is needed and how realistic the proposed care plan will be once she leaves the hospital.

In a busy oncology clinic, such concerns may be recognized without becoming part of the treatment decision. A nurse may notice that the patient needs help walking. A pharmacist may identify potentially important medication-related issues. A family member may explain that transportation is becoming difficult. Unless these observations reach the appropriate clinician and lead to agreed actions, they may have little influence on care.

This is the gap that geriatric assessment can help address.

Geriatric assessment offers a structured approach to identifying health, functional and social concerns that conventional oncology assessment may not fully capture. Identifying these concerns, however, is only the beginning. The greater challenge is translating them into treatment decisions, appropriate supportive care and reliable follow-up.

For Viet Nam, this is an implementation challenge as much as a clinical one. Oncology services operate in hospitals and clinics with different staffing levels, specialist resources and referral capabilities. Establishing a comprehensive geriatric oncology department may be possible in some settings but unrealistic as an immediate requirement for every provider.

A more practical starting point is to understand how an existing oncology team can incorporate relevant geriatric information into the decisions and activities it already performs.

The central question is: How can oncology services translate geriatric assessment into safer systemic treatment decisions, coordinated supportive care and meaningful outcomes for older people?

Answering this question requires a clinical pathway that begins before a new systemic treatment regimen, makes assessment findings available when decisions are being made, assigns responsibility for appropriate interventions and reviews the person's needs as treatment progresses.

The objective is not to reduce treatment intensity simply because someone is older. It is to make cancer care more individualized, address potentially modifiable problems and ensure that the agreed treatment plan can be carried out as safely and effectively as possible.

Geriatric Assessment Should Lead to Action, Not Simply More Documentation

Systemic cancer treatment decisions depend on established clinical considerations, including the characteristics of the malignancy, disease stage, treatment intent, organ function, comorbid conditions, performance status and evidence supporting the proposed regimen. These remain essential, but they do not always explain how an older person manages daily life or whether the practical demands of treatment can be met.

Two patients with the same cancer diagnosis and similar performance status may have substantially different needs. One may live independently, manage medicines reliably and have dependable support. Another may struggle with daily activities, experience memory difficulties or depend on a caregiver who cannot attend appointments regularly. These differences can affect treatment safety, communication, the ability to respond to complications and the feasibility of continuing treatment over time.

Geriatric assessment, usually abbreviated as GA, provides a structured way to understand these differences. The American Society of Clinical Oncology (ASCO) guideline update published in 2023 identifies several important domains, including physical and cognitive functioning, emotional health, comorbidities, polypharmacy, nutrition and social support.

Its recommendations extend beyond recognizing impairments.

For older patients with GA-identified concerns, ASCO recommends geriatric assessment–guided management (GAM). This means using assessment findings to inform cancer treatment decisions and address identified problems through appropriate interventions, counseling or referrals.

The distinction between GA and GAM is central to service quality. If an assessment identifies reduced mobility, the oncology team needs to consider whether that finding affects treatment attendance, movement through the infusion unit or the assistance required at home. If cognitive concerns are identified, the team should consider whether the patient understands the treatment plan and can follow the required instructions.

Similarly, recognizing limited family support is useful only when the team examines how essential appointments, medicines and responses to complications will be managed.

Not every finding requires a specialist referral, and not every problem can be resolved immediately. Some concerns can be addressed through practical adjustments or clearer communication, while others require further professional evaluation. What matters is that clinically relevant findings lead to a considered decision about the appropriate response.

The value of geriatric assessment lies not only in identifying vulnerabilities, but in ensuring that the findings influence care.

For this reason, the most useful model for Viet Nam is not a stand-alone screening initiative. It is a coordinated process connecting assessment, treatment planning, supportive interventions and reassessment, with clear responsibility for carrying out agreed actions.

International Guidance Provides a Foundation for Resource-Appropriate Implementation

ASCO's 2023 guideline update, Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy, provides an important foundation for this approach.

It recommends geriatric assessment to identify aging-related concerns that may not be routinely captured by oncology evaluation. For patients aged 65 years or older with identified impairments, the guideline recommends including GA-guided management in the care plan.

Importantly, the recommendation encompasses patients receiving systemic treatments, including chemotherapy, targeted therapy and immunotherapy.

This broader scope reflects contemporary cancer care, in which treatment options extend beyond conventional cytotoxic chemotherapy. However, different systemic therapies have different mechanisms, adverse-effect profiles and monitoring requirements. The strength of evidence supporting particular geriatric interventions also varies across treatment classes.

A further development came in August 2025, when ASCO published Geriatric Assessment: ASCO Global Guideline in JCO Global Oncology.

The global guideline addresses the challenge of implementing geriatric assessment where clinical personnel, specialist services or other resources may be limited. It organizes recommendations according to basic, limited and enhanced resource settings, providing a practical approach for healthcare organizations with differing capabilities.

At the basic resource level, ASCO recommends including at least a brief geriatric screening tool, identifying the G8 as a recommended option. When screening suggests potential vulnerability, further evaluation may be undertaken using an appropriate assessment method, including ASCO's Practical Geriatric Assessment.

In settings with greater resources, the guideline recommends assessment across the principal geriatric domains and using the findings to develop individualized management plans.

The accompanying Geriatric Assessment: ASCO Global Guideline Clinical Insights, published in November 2025, discusses practical considerations for applying these recommendations in resource-constrained environments.

These publications are relevant to Viet Nam because they recognize that oncology services do not all have dedicated geriatricians, specialized multidisciplinary teams or the capacity to perform extensive assessments for every patient.

Nevertheless, the resource categories should not be used to classify an entire country as though all its healthcare facilities have the same capabilities.

A major oncology hospital may have direct access to geriatrics, rehabilitation, clinical nutrition, pharmacy and psychosocial services. A smaller provider may need to begin with a more limited assessment process and establish referral arrangements with other authorized healthcare organizations.

The appropriate model should reflect the resources actually available, the needs of the patients and the extent to which important findings can be addressed.

International guidance should also be distinguished from binding national requirements. ASCO guidelines are professional recommendations, not Vietnamese legal obligations or mandatory national accreditation standards.

Their importance lies in providing an evidence-informed basis for healthcare organizations to develop clinically appropriate processes without assuming that every facility must adopt an identical organizational structure.

Viet Nam's Legal Framework and the Meaning of Age Eligibility

The age threshold used in international geriatric oncology guidance must be distinguished from Viet Nam's legal definition of an older person.

Under Article 2 of the Law on Older Persons No. 39/2009/QH12, an older person is a Vietnamese citizen aged 60 years or older. ASCO's geriatric oncology guidelines generally address adults with cancer aged 65 years or older.

These definitions serve different purposes.

The ASCO threshold reflects the population addressed by its clinical recommendations and much of the supporting research. It does not establish a mandatory Vietnamese legal age for geriatric assessment or determine who may receive systemic cancer treatment.

A Vietnamese oncology department may reasonably use a threshold aligned with ASCO when defining the initial population for a quality improvement pilot. Such a decision should be explained as a practical clinical and implementation choice, not a legal eligibility rule.

Patients aged 60–64 who have substantial functional, cognitive or other relevant concerns may also benefit from appropriate assessment when clinically indicated. Conversely, chronological age alone should not determine whether chemotherapy, targeted therapy or immunotherapy is offered, withheld or modified.

The Law on Medical Examination and Treatment No. 15/2023/QH15, effective from 1 January 2024 and subsequently amended, provides the principal legal framework for clinical responsibilities and patient rights.

Article 9 addresses the right to receive information and explanations about health conditions, examination and treatment methods, healthcare services, costs and relevant self-care guidance. Article 10 protects patients' dignity, privacy and freedom from discrimination or mistreatment.

Article 11 addresses the right to choose examination and treatment methods after receiving appropriate information, subject to statutory exceptions. Article 13 establishes the right to refuse examination and treatment under the conditions specified by law.

Article 15 addresses the exercise of patient rights in circumstances involving legally recognized limitations in civil capacity, difficulties in cognition or behavioral control, and other specified situations.

These provisions are especially relevant when geriatric assessment identifies possible cognitive impairment.

An abnormal cognitive screening result does not, by itself, establish that an older person lacks legal capacity or cannot participate meaningfully in treatment decisions.

The clinical team should consider whether further assessment is needed and provide appropriate communication and decision-making support. Where representation or other legally significant decisions become necessary, the applicable statutory requirements must be followed.

Article 62 of the Law on Medical Examination and Treatment addresses clinical examination, treatment selection and prescribing responsibilities. Article 63 establishes principles concerning the safe, appropriate and effective use of medicines in treatment.

Government Decree No. 96/2023/NĐ-CP, together with applicable amendments, provides further requirements concerning the organization and licensing of healthcare facilities.

A GA-guided oncology pathway must operate within these professional and organizational boundaries.

Oncology nurses, pharmacists and other healthcare professionals may contribute according to their qualifications, assigned roles and lawful scope of practice. Treatment selection, prescribing and other professional decisions remain the responsibility of appropriately authorized practitioners.

Introducing a screening questionnaire or geriatric assessment procedure does not create independent authority to diagnose disease, prescribe medicines or modify cancer treatment.

These legal distinctions should be reflected in the hospital's clinical workflow and assignment of responsibilities.

Identifying Patients Early Enough for Assessment to Influence Treatment

A practical pathway should begin before a new systemic treatment regimen whenever feasible. At that stage, the oncology team is already reviewing the diagnosis, treatment intent, proposed regimen, organ function, laboratory findings and other factors relevant to treatment.

Adding an appropriate geriatric assessment can help identify concerns while there is still an opportunity to incorporate them into treatment planning and supportive care arrangements.

For an outpatient oncology unit beginning implementation, a clearly defined pilot population may be more manageable than attempting to introduce the same process across the entire hospital immediately.

One reasonable starting point is adults aged 65 years or older preparing to receive a new systemic anticancer regimen. The service should also allow appropriate professional consideration of patients outside that initial population when their condition suggests clinically relevant geriatric needs.

This is a proposed implementation strategy rather than a substitute for ASCO's recommendations.

The department must then decide whether to offer a broader assessment to the selected population or begin with brief screening followed by more detailed evaluation when indicated.

Screening and assessment serve different purposes. A brief screening tool helps identify people who may have vulnerabilities requiring further attention. Geriatric assessment provides additional information to clarify relevant concerns and guide management.

ASCO's 2025 global guideline recommends the G8 screening tool, using a score of 14 or lower as the suggested threshold in basic resource settings.

However, this threshold should not be treated as a universally validated decision rule for every Vietnamese oncology service.

The suitability of the tool depends on factors including language, translation, staff training, administration and the characteristics of the population being assessed. The guideline also recognizes that other appropriate instruments or thresholds may be preferable in some settings when supported by relevant evidence.

A G8 result should not independently determine whether a patient can receive chemotherapy, targeted therapy or immunotherapy. A result above the suggested screening threshold should also not override important clinical concerns or observations raised by the patient, family or treating team.

The process needs to remain clinically responsive.

Assessment should occur early enough to be useful, but it should not become an administrative obstacle to necessary treatment. For a patient who requires time-sensitive therapy, the oncologist must determine which evaluations are essential before treatment and which supportive interventions can appropriately proceed alongside it.

Integrating Assessment Into the Existing Oncology Workflow

One of the main implementation challenges is deciding where geriatric assessment fits into routine oncology care.

A busy outpatient department may already have separate processes for medical consultations, nursing assessments, laboratory investigations, pharmacy review and treatment scheduling. Introducing another form without clearly defining its purpose may increase work while leaving important problems unresolved.

A more effective approach begins by examining how patients are currently prepared for systemic treatment.

The department may find that nurses routinely identify difficulties with mobility or daily activities. Physicians assess comorbidities and treatment risks. Pharmacists review medicines, while administrative or social work personnel may recognize problems with transportation or family support.

Relevant information may already exist, but it may be scattered across different records or unavailable when treatment decisions are made. The objective should be to connect these activities into a reliable pathway rather than duplicate them unnecessarily.

For example, a trained member of the oncology team could initiate appropriate screening before the treatment-planning consultation. Patients who can complete brief questionnaires independently may do so, while assistance should be available when reading, hearing, communication or other difficulties make that impractical.

More detailed evaluation can then be undertaken by qualified professionals according to the findings and available resources.

The treating oncologist should receive a concise summary before making or confirming relevant treatment decisions. That summary should distinguish findings requiring immediate clinical consideration from those that can be addressed through supportive interventions or monitored during treatment.

Not every positive finding requires a separate specialist appointment. Some concerns may be addressed through clarification of instructions, practical support arrangements or appropriate counseling. Others require clinical assessment or intervention by a qualified professional.

The workflow should make these differences clear.

A well-designed process also needs to account for treatment schedules. A questionnaire completed after the treatment decision has been finalized may still identify useful support needs, but it has less opportunity to influence the original treatment plan.

Similarly, a referral made during treatment planning may have limited value if the receiving service cannot respond until much later.

Assessment should therefore be connected with the timing of decisions and the availability of interventions.

The goal is not to complete the longest possible assessment. It is to obtain clinically meaningful information and ensure that the right people can act on it.

Translating Findings Into an Actionable Management Plan

The essential step in GA-guided management is converting assessment findings into decisions and actions.

An assessment may identify several concerns, but simply listing them does not establish what the oncology team intends to do.

Consider a patient who has difficulty walking and reports a recent fall. The oncology team should determine whether these findings affect safe attendance at treatment, mobility within the facility or the support required between visits.

The appropriate response may involve a professional mobility assessment, rehabilitation referral, changes in transportation arrangements or assistance during appointments.

For a patient with possible cognitive impairment, the team may need to consider whether treatment instructions are understandable, whether medication routines can be followed and whether further professional evaluation is warranted.

Additional family involvement may help when the patient wishes it and the legal requirements for sharing information and participating in decisions are met. The finding should not automatically lead to withholding treatment or assuming that relatives must make decisions.

Medication-related concerns may prompt review by a pharmacist or another appropriate professional, particularly where treatment introduces interaction risks or complicates existing medication use. Any prescription changes must follow the applicable professional requirements.

Concerns about emotional well-being, nutrition or social support may require different responses, but the underlying implementation principle is the same.

The team needs to decide whether a finding requires intervention, who should act and how the outcome will be reviewed.

A practical management record can make these responsibilities visible. For each clinically significant concern, it should be possible to identify the agreed action, the responsible professional or service, the expected timing and whether the intervention has been completed, declined, modified or remains pending.

For example, documenting difficulty with medication management is not equivalent to confirming that the regimen has been reviewed and appropriate instructions communicated.

Making a referral is also different from establishing that the patient has accessed the receiving service.

Some interventions will not be available immediately, especially where specialist resources are limited. When an action cannot be completed as planned, the oncology team should consider whether an appropriate alternative exists and whether the unresolved concern affects treatment safety.

This is the point at which geriatric assessment becomes an operational care process rather than an additional documentation exercise.

Geriatric Assessment Supports, but Does Not Replace, Oncology Treatment Decisions

GA-guided management can inform systemic cancer treatment decisions, but it does not replace oncology expertise or the clinical evidence supporting a particular regimen.

The relevant decision depends on the cancer diagnosis, treatment intent, expected benefit, potential toxicity, organ function, concurrent conditions and the patient's informed preferences.

Geriatric assessment adds information about how the person may tolerate treatment and what support may be needed to make the plan feasible. It does not produce a single numerical answer identifying the correct treatment.

The distinction is particularly important when assessing chemotherapy toxicity risk.

Tools such as the Cancer and Aging Research Group (CARG) chemotherapy toxicity risk model may provide useful estimates for patients and regimens within their intended and validated populations. However, such estimates should not be treated as universal predictions for all systemic therapies.

Chemotherapy, targeted treatments and immunotherapy can have substantially different adverse-effect mechanisms and monitoring requirements. A model developed to predict chemotherapy toxicity cannot automatically be assumed to predict immunotherapy-related complications or targeted therapy toxicity with equivalent accuracy.

Likewise, an abnormal geriatric screening result should not automatically trigger chemotherapy dose reduction, treatment postponement or cancellation.

The oncologist must consider the overall clinical circumstances.

An older person with manageable limitations may remain an appropriate candidate for standard-intensity treatment when the anticipated benefit justifies the risks and adequate support can be provided. Another patient may benefit from changes to the regimen, additional supportive interventions or more intensive monitoring.

The goal of treatment also matters.

When treatment is offered with curative intent, preserving an effective cancer treatment strategy may be particularly important. For a person receiving treatment primarily to control advanced disease, the balance between expected benefit, toxicity, functional outcomes and treatment burden may be different.

These considerations require discussion with the patient.

A geriatric assessment may reveal problems that can be addressed before treatment begins. Others may be managed while treatment proceeds. The team should not automatically delay necessary therapy until every identified concern has been resolved.

Instead, the responsible oncologist should determine which issues require action before treatment and which can be managed through a coordinated plan during subsequent visits.

Geriatric assessment is not intended to identify older people who should receive less cancer treatment. It is intended to help clinicians and patients choose treatment and support that better reflect the individual's clinical condition, priorities and likely ability to tolerate care.

What Clinical Trials Demonstrate—and Their Limits

Randomized clinical trials provide important evidence supporting geriatric assessment–guided management, particularly for older people receiving chemotherapy.

The GAP70+ trial, published in The Lancet in 2021, enrolled adults aged 70 years or older with advanced, incurable solid tumors or lymphoma, at least one identified geriatric impairment and a planned new cancer treatment regimen. Most participants received chemotherapy.

The intervention involved providing oncologists with a tailored geriatric assessment summary and management recommendations.

Grade 3–5 treatment-related toxic effects occurred in approximately 51% of patients in the intervention group, compared with 71% receiving usual care.

The trial supports the use of assessment-informed management to reduce serious treatment toxicity in the population studied.

The GAIN trial, published in JAMA Oncology in 2021, evaluated a multidisciplinary intervention based on geriatric assessment among older adults beginning chemotherapy.

Grade 3 or higher chemotherapy-related toxic effects occurred in 50.5% of patients receiving the intervention, compared with 60.6% in the usual-care group.

The study demonstrated a statistically significant reduction in serious toxicity. These findings are clinically important because the interventions involved acting on assessment results rather than simply recording geriatric vulnerabilities.

However, they should be interpreted within the populations, treatment settings and intervention models evaluated. They do not establish that every locally developed geriatric assessment program will produce the same results, nor do they demonstrate equivalent toxicity reductions across all targeted treatments or immunotherapies.

Later research illustrates both the potential for adaptation and the importance of measuring the right outcomes.

The GAIN-S randomized trial, published in the Journal of the National Comprehensive Cancer Network in 2025, evaluated a telehealth-supported geriatric assessment and supportive care intervention among 80 older adults with metastatic cancer in Brazil.

The study reported improvements in physical function and several patient-reported outcomes compared with usual care over three months. It offers an example of how GA-guided interventions may be organized across locations using remote professional support.

However, the study was conducted within a particular oncology network, and its findings should not be interpreted as proof that an identical telehealth model would be feasible or equally effective in every Vietnamese healthcare setting.

The GOSPEL randomized trial, published in the Journal of Geriatric Oncology in 2026, evaluated a geriatric oncology supportive clinic among older patients undergoing curative-intent treatment involving chemotherapy and/or radiotherapy.

The single-center trial included 52 participants aged 65 years or older whose G8 screening results indicated potential vulnerability.

The study did not demonstrate a statistically significant difference between the intervention and usual-care groups in its primary quality-of-life outcome.

A secondary quality-of-life measure improved over time within the intervention group, but this finding should not be interpreted as proof of a significant comparative benefit over usual care.

The study also did not demonstrate statistically significant between-group differences in treatment-related toxicity, healthcare utilization or survival outcomes.

Its results should not be treated as contradicting all earlier evidence. The population, intervention, treatment setting and outcomes differed from those of GAP70+ and GAIN, and the trial was relatively small.

They do reinforce an important lesson: the effects of geriatric oncology interventions depend on what is delivered, to whom, and which outcomes are assessed.

Evidence from Viet Nam provides additional context.

A 2026 study conducted at University Medical Center Ho Chi Minh City examined 180 patients aged 60 years or older with colorectal cancer who were receiving chemotherapy.

The investigators assessed geriatric characteristics and examined their associations with chemotherapy regimen changes over a three-month follow-up period.

The study identified vulnerabilities across several domains. Exploratory analyses found associations between certain characteristics, including dependence in basic activities of daily living and fall risk, and subsequent treatment modifications.

However, the findings require cautious interpretation.

The study was observational, involved one clinical setting and used exploratory statistical analyses. The reported associations do not establish that geriatric assessment caused treatment changes or improved clinical outcomes.

The findings also cannot be generalized automatically to other cancer types, systemic therapies or oncology facilities in Viet Nam.

Their value is that they demonstrate the relevance of examining geriatric concerns within Vietnamese oncology practice while highlighting the need for further implementation and outcomes research.

Taken together, international trials and emerging local evidence support a practical direction: oncology services should move beyond identifying geriatric vulnerabilities and develop reliable processes for responding to them.

The evidence does not justify assuming that completing an assessment form, without appropriate management, will improve outcomes.

Coordinating Supportive Care Without Establishing an Entirely New Department

A hospital may recognize the value of geriatric assessment but have limited access to geriatricians or specialized geriatric oncology services.

This is a genuine implementation challenge. However, GA-guided management does not necessarily require every hospital to establish a separate multidisciplinary department before beginning.

An initial pathway can be developed within existing oncology services.

The treating oncologist remains responsible for cancer treatment decisions within the applicable professional framework.

Oncology nurses may contribute to assessment, patient education, communication and recognition of concerns requiring further professional attention.

Pharmacists may address medication-related issues within their authorized responsibilities. Nutrition, rehabilitation, psychological, palliative care and other specialists may become involved when clinically appropriate and available.

Administrative and social work personnel may help with appointment arrangements, access to support services and relevant practical concerns.

Their contributions are different but can be coordinated through an agreed workflow.

Not every patient requires a formal multidisciplinary meeting. For patients with relatively straightforward findings, a concise assessment summary and documented management plan may be sufficient to guide the responsible clinicians.

More complex cases may require direct discussion among several professionals or a formal consultation.

The critical issue is whether the team can identify who is responsible for each necessary action.

A referral to another service should not automatically be regarded as completed care. The patient may be unable to attend, the appointment may be delayed or the receiving provider may not have the necessary resources.

When an unresolved issue could affect treatment safety, the oncology team should have a process for reviewing the situation and deciding what happens next.

In resource-constrained settings, supportive care may be provided by other authorized healthcare organizations rather than exclusively within the cancer center.

Such arrangements can be useful when communication, referral responsibilities and access are sufficiently reliable.

However, a referral agreement does not expand a provider's legal authority or guarantee that every intervention will be available.

A realistic program should therefore be designed around actual service capabilities, not an idealized multidisciplinary structure that cannot be maintained.

Reviewing Needs During the First Treatment Cycles

Assessment before treatment provides an important baseline, but the patient's needs may change after systemic therapy begins.

Someone who was independent at the initial consultation may become more fatigued or need help with daily activities. Medication routines may become more complicated as supportive treatments are added. Transportation arrangements that worked before treatment may become difficult to sustain.

For these reasons, the GA-guided pathway should include reassessment at clinically appropriate points.

The purpose is not to repeat every component of a comprehensive geriatric assessment before each treatment cycle. Instead, the team should identify which concerns require follow-up, whether planned interventions have occurred and whether new problems have emerged.

The monitoring arrangements should reflect the cancer regimen, anticipated adverse effects, the patient's clinical condition and available professional support.

Some concerns can be reviewed during scheduled treatment visits. Others may require earlier clinical contact or more frequent assessment.

A telephone call may be useful for clarifying instructions or confirming that a support arrangement has been made, but it should not replace a necessary clinical examination.

The service must also distinguish planned follow-up from urgent assessment.

Patients receiving systemic cancer therapy need clear instructions about which symptoms require prompt medical attention and how to contact an appropriate healthcare service.

Depending on the regimen, a new fever during potentially myelosuppressive treatment, severe breathing difficulty, marked deterioration or another potentially serious complication may require urgent assessment.

The appropriate response must follow relevant clinical protocols and the judgment of authorized healthcare professionals.

Patients and family caregivers should not be expected to diagnose treatment complications or independently decide whether a potentially serious symptom can wait until the next routine appointment.

The GA-guided plan should also be reconsidered when treatment changes.

A regimen modification, interruption, switch to another therapy or significant change in functioning may alter the support required.

Regular reassessment ensures that geriatric information continues to inform care rather than becoming a one-time record that is no longer relevant to the patient's current condition.

Patient Preferences and Family Support Must Be Reflected in the Care Plan

Systemic cancer treatment often requires repeated visits and substantial activity outside the oncology department.

Some patients travel long distances for treatment. Others depend on relatives to arrange appointments, obtain medicines or provide daily assistance.

A treatment plan may be clinically appropriate yet difficult to complete because of transportation, financial or caregiving barriers.

These circumstances should be considered when developing GA-guided management.

For example, if assessment identifies limited social support, the team may need to clarify whether the patient can attend treatment safely and obtain timely medical attention when necessary.

This does not mean assuming that every older person needs a caregiver.

Some patients remain fully independent. Others require help with selected practical tasks, while a smaller group may need more extensive support.

The level of assistance should reflect individual needs and preferences.

Family members may provide valuable information and help the patient carry out the agreed plan. However, their involvement should not automatically replace the person's own role in treatment decisions.

When communication or cognitive difficulties are identified, the team should provide appropriate support and arrange further professional evaluation where needed.

Decisions involving legal representation must follow applicable Vietnamese law rather than rest on the assumption that a positive cognitive screening result transfers decision-making authority to relatives.

The patient should know how to contact the oncology service, what to do if the usual contact is unavailable and when urgent assessment is required.

Where practical barriers exist, appropriate personnel may help explore available resources or alternative arrangements.

However, the service should not imply that transportation, financial assistance or specialist supportive care is universally available or publicly funded.

The aim is to make treatment planning realistic for the person's circumstances without shifting unsupported responsibilities onto families.

Responsible Documentation and Protection of Health Information

Geriatric assessment may involve sensitive information about health conditions, functioning, cognition, emotional well-being and social circumstances.

These data can help clinicians provide individualized care, but they should be handled responsibly.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15, effective from 1 January 2026, and Government Decree No. 356/2025/NĐ-CP provide a relevant framework for personal data processing.

Healthcare organizations need to consider the applicable legal basis for collecting and using assessment information, appropriate access permissions, confidentiality and secure sharing between professionals or services.

Family involvement does not authorize unrestricted disclosure of a patient's medical information.

Where the patient wishes relatives to participate, information sharing should comply with the relevant legal requirements.

Digital assessment forms and electronic records may simplify documentation, but they also require suitable controls.

A service should collect information relevant to its defined clinical purpose and ensure that the resulting records are useful to those responsible for care.

Long assessment documents can be difficult to use when the most important findings and required actions are buried within numerous fields.

A concise clinical summary, supported by the appropriate underlying record, may be more effective.

The summary should identify the concerns relevant to the treatment plan, actions already completed, actions requiring further attention and the professionals responsible.

Documentation should support decision-making and continuity, not become an additional administrative burden without clinical value.

Starting With One Outpatient Oncology Unit in Viet Nam

A practical implementation strategy is to begin with a clearly defined outpatient oncology unit rather than an immediate hospital-wide program.

The initial population could include patients aged 65 years or older preparing to begin a new systemic anticancer regimen, with appropriate clinical discretion to assess other patients who have significant geriatric concerns.

The department should first examine how patients currently move from treatment planning to the beginning of therapy.

This review may reveal that important information is already collected but not consistently available to the oncologist. It may also show that assessments are completed too late to influence treatment decisions or that supportive care recommendations are not followed through.

These findings should shape the pilot.

The service can then define when screening or assessment occurs, who performs it, which instruments are suitable and how results reach the treating team.

Where resources are limited, the department may begin with brief screening followed by more detailed assessment for selected patients.

However, the chosen approach should not prevent clinicians from requesting further evaluation when concerns arise, regardless of a screening score.

The pilot should also establish how important findings will be managed.

A concise action record may include the identified concern, agreed intervention, responsible person, expected timing and current status.

Some issues may be addressed during the same visit. Others require referral or further professional evaluation.

The team should determine how it will review unresolved actions, particularly when treatment is scheduled to begin before every supportive intervention can be completed.

The regimen mix should also be considered.

A pilot involving chemotherapy may be easier to evaluate against evidence from trials such as GAP70+ and GAIN. A broader pilot involving targeted therapy and immunotherapy may be appropriate when the team has the required expertise and clear treatment-specific monitoring arrangements.

Neither approach should assume that all systemic therapies carry the same risks or require identical supportive measures.

An appropriate clinical lead should be designated, alongside operational responsibility for assessment, documentation, referrals and follow-up.

Staff training should focus on what happens after a finding is identified, not merely how to complete the assessment.

Early cases should be reviewed to determine whether the process is manageable and whether recommendations are reaching the appropriate professionals.

The team may discover that a questionnaire is too long, patients need assistance completing it or a referral pathway is unreliable.

These are reasons to adjust the process before expanding.

The first goal is not to achieve the largest possible number of assessments. It is to establish a workflow in which assessment findings consistently reach clinical decision-makers and lead to appropriate responses.

Measuring Quality From Assessment to Patient Outcomes

A GA-guided oncology program should not define success solely by the number of people screened or assessed.

Assessment coverage is useful, but it does not show whether important findings influenced care.

A department may complete assessments for most eligible patients while failing to act on significant concerns.

A useful quality framework should therefore examine the entire pathway.

The first area is timely identification and assessment.

The service may review whether patients in the intended population are recognized, whether the chosen assessment occurs at an appropriate time and whether relevant findings reach the treating oncologist before the corresponding clinical decision.

The second area is management of identified concerns.

The program may examine whether significant findings lead to an agreed response, whether responsibility is assigned and whether necessary interventions are completed or reviewed.

The timing of action matters.

For example, a supportive intervention may have limited preventive value if it is arranged only after the problem it was intended to address has already caused difficulty.

However, not every intervention must be completed before cancer treatment begins. The appropriate timing depends on clinical urgency, treatment intent and the nature of the concern.

Patient understanding and experience provide another dimension.

Older people may be asked whether they understand their treatment plan, know whom to contact when problems arise and feel that their priorities have been considered.

Functioning and treatment burden are also relevant.

For some patients, maintaining the ability to perform meaningful daily activities may be an especially important outcome alongside cancer control.

Clinical measures may include serious treatment-related toxic effects, unplanned hospital visits, treatment interruptions and other outcomes appropriate to the patient population and regimen.

These results require careful interpretation.

More frequent dose reductions do not automatically mean better care. They may reflect appropriate individualization, but they may also arise from treatment complications or other clinical circumstances.

Likewise, fewer hospital admissions do not necessarily indicate safer care if patients cannot access appropriate treatment when serious problems occur.

Comparisons should account for differences in cancer stage, treatment intent, regimen, baseline vulnerabilities and other relevant factors.

Changes observed after implementation should not automatically be attributed to geriatric assessment without an appropriate evaluation design.

A small, reliable set of indicators may be more useful initially than an extensive measurement system that the department cannot maintain.

The proposed measures should support local quality improvement. They are not a nationally mandated Vietnamese geriatric oncology accreditation framework or a substitute for existing professional standards governing cancer care.

The purpose is to determine whether assessment leads to action and whether the resulting process supports care that is safer, more coordinated and more responsive to patients' needs.

Governance Must Ensure That Findings Lead to Accountable Decisions

The success of a GA-guided pathway depends on clear professional and operational accountability.

A hospital may invest in screening instruments, staff education and electronic forms, yet still achieve limited benefit if important findings are not reviewed or acted upon.

Clinical governance should define who evaluates assessment results, how the results inform treatment decisions and when additional professional assessment is required.

Operational governance should address staff training, records, referral coordination, monitoring and improvement of the workflow.

The process should also account for situations in which an intended action cannot be completed.

An assessment may be delayed because a patient is unwell. A supportive service may be unavailable. A patient may decline an intervention after receiving appropriate information.

These circumstances do not automatically indicate poor care.

However, the responsible team should understand whether the unresolved issue affects treatment safety and whether another appropriate response is needed.

Reviewing difficult cases can identify practical weaknesses.

A patient may experience serious toxicity despite receiving a geriatric assessment. Another may receive inconsistent instructions because communication between professionals was incomplete. A third may be unable to attend a supportive care appointment because transportation arrangements failed.

The purpose of review is to determine whether the pathway functioned as intended and whether changes could improve future care.

Not every adverse outcome is preventable, and governance should not become an exercise in assigning blame whenever a complication occurs.

It should support professional judgment, reliable communication and learning.

Sustainability also requires realistic leadership and workforce arrangements.

When assessment becomes an additional task without adequate time, training or responsibility for subsequent action, staff may struggle to maintain the process.

A manageable, consistently performed pathway is more valuable than an elaborate assessment program that produces extensive records but little coordinated care.

From Geriatric Assessment to Safer Systemic Cancer Care

Age-friendly oncology care requires more than recognizing that older people may have different needs during cancer treatment.

The greater challenge is ensuring that those differences are reflected in treatment decisions and addressed through an accountable care process.

For the older woman preparing to begin systemic treatment, concerns about mobility, weight loss, medication management and family support should not remain disconnected observations.

The oncology team needs to decide which findings require further evaluation, whether they affect the proposed treatment and what support can be organized before or during therapy.

The patient should understand the expected benefits and risks of treatment, participate in decisions and know how to obtain help when concerns arise.

Her daughter may contribute practical support, but the patient's own preferences and rights remain central.

Qualified healthcare professionals should review treatment-related risks and adjust the care plan when clinically appropriate. Supportive interventions need identifiable responsibility, and unresolved concerns should not disappear after the first treatment cycle.

The central question remains: How can oncology services translate geriatric assessment into safer systemic treatment decisions, coordinated supportive care and meaningful outcomes for older people?

The answer is to treat geriatric assessment as the beginning of a coordinated clinical process rather than the conclusion of a screening exercise.

The oncology team identifies relevant needs before treatment, uses the findings to support individualized decisions, arranges appropriate interventions and reviews the plan as treatment continues.

For Viet Nam, this can begin within one outpatient oncology unit, building on existing personnel and referral arrangements where feasible.

It does not require every hospital to establish a comprehensive geriatric oncology department immediately. It does require professional accountability, a workable process for acting on findings and an understanding of the resources needed to sustain care.

High-quality age-friendly oncology care is not measured only by how many geriatric assessments are completed or how often treatment intensity is modified. It depends on whether assessment findings lead to appropriate decisions, necessary support is delivered and older people can pursue cancer treatment with informed choice, safety and dignity.

As Viet Nam continues to develop age-friendly and integrated healthcare services, geriatric assessment–guided systemic cancer care offers a practical opportunity to connect specialized oncology treatment with the broader needs of older people while strengthening quality, coordination and clinical accountability.

References

1. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. Adopted 9 January 2023; effective 1 January 2024, as amended.

2. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH of the Law on Medical Examination and Treatment. 26 February 2026.

3. Government of Viet Nam. Decree No. 96/2023/NĐ-CP detailing certain provisions of the Law on Medical Examination and Treatment. 30 December 2023, as amended.

4. National Assembly of Viet Nam. Law on Older Persons No. 39/2009/QH12. 23 November 2009, as amended.

5. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. Adopted 26 June 2025; effective 1 January 2026.

6. Government of Viet Nam. Decree No. 356/2025/NĐ-CP detailing certain provisions and measures for implementing the Law on Personal Data Protection. 31 December 2025; effective 1 January 2026.

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8. Bergerot CD, Temin S, Verduzco-Aguirre HC, et al. Geriatric Assessment: ASCO Global Guideline. JCO Global Oncology. 2025;11. DOI: 10.1200/GO-25-00276.

9. Verduzco-Aguirre HC, Temin S, Bergerot CD, Soto-Perez-de-Celis E. Geriatric Assessment: ASCO Global Guideline Clinical Insights. JCO Global Oncology. 2025;11. DOI: 10.1200/GO-25-00309.

10. Mohile SG, Mohamed MR, Xu H, et al. Evaluation of Geriatric Assessment and Management on the Toxic Effects of Cancer Treatment (GAP70+): A Cluster-Randomised Study. The Lancet. 2021;398(10314):1894–1904. DOI: 10.1016/S0140-6736(21)01789-X.

11. Li D, Sun CL, Kim H, et al. Geriatric Assessment–Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults With Cancer: A Randomized Clinical Trial. JAMA Oncology. 2021;7(11). DOI: 10.1001/jamaoncol.2021.4158.

12. Bergerot CD, Bergerot PG, Razavi M, et al. Telehealth Geriatric Assessment and Supportive Care Intervention (GAIN-S) Program: A Randomized Clinical Trial. Journal of the National Comprehensive Cancer Network. 2025;23(6):219–226. DOI: 10.6004/jnccn.2025.7020.

13. The Than Ha Ngoc, Tien Nguyen Ngoc Hoanh My, Trang Truong Thi Thu, et al. Comprehensive Geriatric Assessment in Older Cancer Patients Undergoing Chemotherapy at University Medical Center Ho Chi Minh City. Vietnam Journal of Community Medicine. 2026;67(cd10). DOI: 10.52163/yhc.v67icd10.6195.

14. Goh WY, Ho FCH, Neo HY, et al. Effect of Comprehensive Geriatric Assessment and Supportive Care on Quality of Life in Older Patients With Cancer Receiving Curative Treatment: The GOSPEL Randomised Controlled Trial. Journal of Geriatric Oncology. 2026;17(6):103010. DOI: 10.1016/j.jgo.2026.103010.