Geriatrics for geriatric oncology

Abstract

Background: The majority of cancer patients are older, and such patients represent an unique challenge for oncologists. Chronological age is a poor surrogate for determining risk of complications from treatment and life expectancy. Few older adults with cancer are included in clinical trials (1). Many older adults have coexisting diseases accompanied by polypharmacy which may interfere with cancer treatment. Traditional measures of performance status in older adults with cancer do not capture their true functional status. Thus, in order to tailor treatment it is recommended to perform a geriatric assessment (GA) which evaluates functional status, comorbidity, polypharmacy, cognitive function, emotional function, nutritional status and social support (2). Through a GA the oncologist can identify patients who are frail. Frail patients have an increased risk of negative outcomes from treatment. Objective/methods: To review studies of GA in cancer treatment in older individuals, with a particular focus on studies that investigate treatment complications, mortality, and functional decline. Result(s): A pre-treatment GA may identify patients who are frail and thus at high risk for treatment complications and mortality, both in the surgical setting and in medical oncology. A broad assessment is necessary in order to avoid overtreatment of frail patients and undertreatment of fit patients (3). Conclusion(s): To provide optimal care for older patients with cancer, the oncologist needs to assess function, mobility, cognition, frailty and comorbidity in addition to traditional cancer specific measures. A GA may aid clinical decision-making and identify remediable problems, and thus provide an opportunity to optimize frail patients.