NCCN Guidelines Insights: Older Adult Oncology, Version 2.2016

Abstract

Cancer is the leading cause of death in older adults aged 60 to 79 years. Older patients with good performance status are able to tolerate commonly used treatment modalities as well as younger patients, particularly when adequate supportive care is provided. For older patients who are able to tolerate curative treatment, options include surgery, radiation therapy (RT), chemotherapy, and targeted therapies. RT can be highly effective and well tolerated in carefully selected patients, and advanced age alone should not preclude the use of RT in older patients with cancer. Judicious application of advanced RT techniques that facilitate normal tissue sparing and reduce RT doses to organs at risk are important for all patients, and may help to assuage concerns about the risks of RT in older adults. These NCCN Guidelines Insights focus on the recent updates to the 2016 NCCN Guidelines for Older Adult Oncology specific to the use of RT in the management of older adults with cancer.

Immune Checkpoint Inhibitors in Real‐World Treatment of Older Adults with Non–Small Cell Lung Cancer

“…37 Currently, GA is recommended to aid in such decision making for older adults with cancer by multiple organizations including the SIOG, American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network. 34,38,39 Given the established utility of the GA and the increased risk of toxicity as demonstrated by our study as well as others, further study on GA in the setting of ICIs is needed to identify patients with low physiologic reserve who are at risk of experiencing functional decline and death from ICIs. There is also a need to increase enrollment of older patients onto randomized clinical trials, the gold standard of evidence-based medicine, and ASCO has developed recommendations to improve the evidence base for older patients with cancer.…”

“…In addition, GA may be able to better define older patients’ functional status (“physiologic age”) rather than reliance merely on age cutoffs (“chronologic age”) . Currently, GA is recommended to aid in such decision making for older adults with cancer by multiple organizations including the SIOG, American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network . Given the established utility of the GA and the increased risk of toxicity as demonstrated by our study as well as others, further study on GA in the setting of ICIs is needed to identify patients with low physiologic reserve who are at risk of experiencing functional decline and death from ICIs.…”

What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper

“…55 International organizations have also recommended that a geriatric assessment be performed in all older patients-those age 70 years or older-or at least in those older patients before the initiation of anticancer therapy. 3,4 The selection of the age cutoff may also depend on available resources.…”

“…Although recommended by the National Comprehensive Cancer Network and the International Society of Geriatric Oncology (SIOG), geriatric assessment is not routinely implemented in oncology practice as it is perceived to be time and resource consuming. 3,4 Although the time commitment and burden on patients and caregivers are concerns, recently developed cancer-specific geriatric assessment tools can gather a wealth of information in a relatively short amount of time. 5,6 In this work, we briefly describe the utility of geriatric assessment in the care of older adults with cancer and provide a practical approach to geriatric assessment in oncology.…”

The role of Internet cancer information for older adults with cancer: Perspectives of older adults and healthcare professionals

“…One in 2 Canadians will be diagnosed with cancer in their lifetime, and currently, almost 90% of Canadians who develop cancer are over the age of 50 (Canadian Cancer Society, ). Whereas all individuals diagnosed with cancer face physical and psychosocial distress related to their illness, older adults might also face alterations in cognition and functional status related to the normal ageing process as well as amplified adverse effects related to chemotherapy and radiation (Vanderwalde et al, ). Older adults may also encounter age‐related bias about their treatment and information preferences as well as exclusions from a vast array of clinical and psychosocial treatments related to their age, functional status and increased likelihood of comorbidities (Puts et al, ; Wildiers et al, ).…”