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Introduction - Chapter 03

Chapter 03 - Evaluation of the senior cancer patient: Comprehensive Geriatric Assessment and screening tools for the elderly

Since ageing is the main risk factor for cancer, most cancer patients are elderly. Many of these patients have accompanying comorbidities or geriatric problems (Table 1).

Table 1. Prevalence of problems in older cancer patients: outpatient oncology clinic setting

ProblemsPrevalence
ECOG PS >= 2~ 20 %
ADL dependence~ 20 %
IADL dependence50-60 %
Comorbidity>90 %
Severe comorbidity30-40 %
Depression20-40 %
Cognitive impairment25-35 %
At risk of malnutrition/malnourished30-50 %

Abbreviations: ECOG: Eastern Cooperative Oncology Group; PS: performance score; ADL: activities of daily living; IADL: instrumental activities of daily living.

In an oncology setting, not all of these problems might need a comprehensive approach beyond what would normally be applied in the general adult population.

In our experience, half of patients aged 70 and older are functionally “old adults” and can be treated with a standard oncologic approach. However, the other half will need more comprehensive care, including a comprehensive geriatric assessment (CGA). The challenge for the oncologist is to distinguish between these two populations. Recent and ongoing research in geriatric oncology has started identifying effective short screening tools that can be used in a busy setting. Some of these have actually been tested in emergency rooms and then adapted for use in an oncology setting. The general work-up of an older cancer patient is outlined in the Figure below.

General approach to treatment planning in an older cancer patient

One should note the importance of doing an early geriatric screening. This allows using the 2-4 weeks usually needed for an oncology work-up to perform a parallel geriatric work-up, if necessary. We provide resources below to accomplish this two-step approach to the onco-geriatric evaluation of older cancer patients.

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