Advances in geriatric oncology: a multidisciplinary perspective

Abstract

A growing majority of people with cancer is composed of older patients. For many such patients, independence and quality of life are as important as prolongation of survival, emphasizing the need for treatments that are not only effective but also well-tolerated. Given age-related decline in organ function and the prevalence of comorbidities and polypharmacy, optimum management is complex and requires collaboration between oncologists and geriatricians. Advances in surgery now include preoperative assessment and, when indicated, prehabilitation of the patient, as well as the enhanced recovery after surgery approach. Medical treatment is benefiting from the advent of highly effective novel immunomodulatory agents that join the tumor-targeted small molecule tyrosine kinase inhibitors and monoclonal antibodies in modifying the tolerability of therapy. Improved tolerability is evident with radiotherapy (RT). The adoption of stereotactic body RT in community oncology practice is increasing the proportion of elderly patients with comorbidities who can receive curative treatment. A further aspect of precision medicine as it relates to the older cancer patient is the tailoring of intervention to the robustness or frailty and life expectancy of the individual. Quantitative and validated tools for comprehensive geriatric assessment are playing an important role in this process.

Geriatric impairments are prevalent and predictive of survival in older patients with cancer receiving radiotherapy: a prospective observational study

“…Our work thereby expands the current evidence for the predictive value of GA, which hitherto mainly has been documented in older patients treated with systemic cancer therapy and cancer surgery (146,180,221,222). Since it is estimated that over 50% of patients with cancer will need RT at some point (234,235), we believe this work contributes with valuable knowledge that may benefit patients in the future.…”

“…There are few studies investigating the prevalence of age-related health problems, and their impact on older patients' tolerance and outcomes of RT. This is disturbing, as an estimated 50-60% of all patients with cancer will require RT at some point during their disease trajectory (234,235).…”

Pancreaticoduodenectomy in octogenarian patients with tumors in the head of the pancreas and periampular region

“…Ante un tratamiento oncológico, hay que considerar los riesgos previsiblemente asociados con la terapia elegida y los superiores beneficios que se puedan obtener en términos de supervivencia, calidad de vida y mantenimiento de la reserva funcional (9). El tratamiento oncológico debe ser seguro en los pacientes geriátricos con aceptable edad biológica, aunque sin obviar determinados factores como el estado psicosocial y familiar, comorbilidad, fragilidad y tratamientos médicos que pueden suponer un riesgo para los pacientes (10).…”

Geriatric Oncology in the Instagram Era: Feasibility and Acceptability Randomised Controlled Trial on Adopting PhotoVoice to Enable Empowerment, Patient-Centred Care, and Shared Decision Making—Study Protocol

“…Despite growing recognition of the importance of GA in guiding geriatric oncological treatment decisions, implementation remains limited. Only 36% of surgical oncologists collaborate with geriatricians, and 48% consider GA essential for decision making [ 19 ]. Time constraints and performance targets driven practice and MDTs that focus primarily on cancer pathology and treatment may neglect essential patient-centred information, leading to overtreatment and poor outcomes [ 3 , 20 ].…”