Basic Assessment of the Older Cancer Patient

Abstract

Cancer is a disease of the elderly (median age 67 in the US), and this is a population with a variable health status. Therefore, treating the older half of the cancer population will present the challenge of not only addressing tumor diversity (the side often referred to in "personalized cancer care" discussions), but patient diversity as well as the interaction between these two heterogeneities. In that sense, geriatric oncology is the ultimate personalized cancer care. In this article, we will address the recent updates in the basic assessment of the patient's condition, and their implication for clinical and research use. The main progresses reported in the last couple of years pertain to geriatric screening tests, and to prediction of the tolerance to treatment. Some important data on the impact of comorbidities on cancer behavior have emerged, but the clinical implications of these data are still being sorted out. We recommend a two-step approach to the basic evaluation of the older cancer patient. First a short screening with a tested screening instrument. Then further work-up of the geriatric findings in parallel with the oncology work-up to define an integrated treatment plan.

Second line therapy with axitinib after only prior sunitinib in metastatic renal cell cancer: Italian multicenter real world SAX study final results

“…Fifteen percentage of our study population was over 75 years, normally under-represented in clinical trials [28]. The elderly patients are usually a frail population with a lower performance status (PS), poor tolerance to medical treatments and multiple co-morbidities [29]. To date few data are available concerning the use of axitinib in elderly mRCC patients [30–32].…”

Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study

“…The decision to initiate chemotherapy in older adults is an important task facing oncologists and entails considering a number of factors including life expectancy, treatment benefit and tolerance, and availability of social support, along with considerations to minimize treatment toxicity [ 30 – 32 ]. Recently the use of geriatric assessment has been recommended to help make chemotherapy treatment decisions in older adults [ 16 , 33 ] by assessing the level of frailty and functional impairments as well as determining remaining life expectancy in the context of their other health conditions.…”

Comorbidity and geriatric assessment for older patients with hematologic malignancies: A review of the evidence

“…Several screening instruments are available and the interested reader is invited to refer to a recent review of the data. 5 CGA and geriatric interventions have been demonstrated to correlate with cancer prognosis, treatment outcomes and treatment modifications. [6][7][8][9][10][11][12] However, these data have been acquired mostly in patients with solid tumors or general groups with few hematologic tumor patients.…”