Practical Geriatric Assessment (PGA) Implementation Strategies and Correlative Evaluations (PACE-70): Protocol for a hybrid implementation-effectiveness study in three community oncology practices in the United States

This protocol paper describes the design of PACE-70, a hybrid implementation-effectiveness study evaluating strategies for integrating Practical Geriatric Assessment into routine oncology care across three community practice sites for patients aged 70 and older with cancer. The study aims to assess both the effectiveness of geriatric assessment in guiding treatment decisions and the implementation strategies that best support its adoption in real-world community oncology settings, where the majority of older adults with cancer receive their care. The hybrid design allows simultaneous evaluation of clinical outcomes and implementation processes, providing a more complete picture of how geriatric assessment tools can be scaled.

This work addresses a critical gap in oncology care for older adults, who represent the majority of cancer patients yet are frequently undertreated or overtreated due to insufficient attention to functional status, comorbidities, and individual goals of care. By focusing on community practices rather than academic centers, PACE-70 is positioned to generate evidence that is both scientifically rigorous and directly applicable to the settings where it is needed most, with the potential to meaningfully improve the safety and appropriateness of cancer treatment for a growing and often underserved population.