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Why geriatric oncology?

Treatment of cancer in older adults is more complex than younger persons because of comorbidities, competing risks of death, potentially altered treatment tolerance, and variable patient preferences.

Older adults, also those with comorbidities, are willing to take a cancer treatment as long as it does not impact their function or their cognition.

Geriatric Oncology is about:

  • how should oncologists be individualizing their treatment approach based on the risks and benefits of therapy?
  • what instruments can help oncologists to have a better view of the patient’s overall health situation?
  • how does the cancer and the cancer treatment impact the aging process of the patient?

Geriatric Oncology: A Multidisciplinary Approach in a Global Environment by Gouri Shankar Bhattacharyya, MD, and Stuart M. Lichtman, MD. The ASCO Post, June 10, 2017

Geriatric Assessment

Geriatric assessment provides an overview of the general health status of older individuals and determines the functional and physiological age, which is more important than chronological age.

Geriatric assessment includes several important domains: functionality, nutrition, cognition, psychological state, social support, comorbidities, medication review, and geriatric syndromes.

Geriatric assessment helps Oncologists to:

  • understand the overall health status of the patient
  • identify previously unknown health problems
  • predict life expectancy of the patient
  • predict tolerance of treatments
  • influences treatment choices
  • identify geriatric interventions that can improve treatment tolerability and compliance

 

HOW: Tools

  1. Screening tools: Screening tools only take a few minutes, and can be used in busy practices to distinguish fit older patients (+/- 30% of the 70+ cancer population) versus older cancer patients at risk for geriatric deficiencies (+/- 70% of the 70+ cancer population). The latter group certainly requires a full CGA (below)
  2. Full CGA (Comprehensive Geriatric Assessment):  comprises a systematic evaluation of the most important geriatric assessment domains.

 

How does this work?

Several models to implement geriatric assessment exist, and it is probably best to use geriatric assessment tools and geriatric expertise according to local/national habits in the geriatric community.

European Model: Many European countries work with geriatric screening tools, and only full CGA when the screening test shows a geriatric risk profile. This system has the advantage that a full CGA, which is time consuming, is done only for those who really need it.

USA Model: Many centres work with patient completed geriatric questionnaires. This has the advantage that the workload is mainly done by the patient (or caregiver)