Geriatric assessment and treatment decision-making in surgical oncology

Abstract

Purpose of reviewPresent an approach for surgical decision-making in cancer that incorporates geriatric assessment by building upon the common categories of tumor, technical, and patient factors to enable dual assessment of disease and geriatric factors. Recent findingsConventional preoperative assessment is insufficient for older adults missing important modifiable deficits, and inaccurately estimating treatment intolerance, complications, functional impairment and disability, and death. Including geriatric-focused assessment into routine perioperative care facilitates improved communications between clinicians and patients and among interdisciplinary teams. In addition, it facilitates the detection of geriatric-specific deficits that are amenable to treatment. We propose a framework for embedding geriatric assessment into surgical oncology practice to allow more accurate risk stratification, identify and manage geriatric deficits, support decision-making, and plan proactively for both cancer-directed and non-cancer-directed therapies. This patient-centered approach can reduce adverse outcomes such as functional decline, delirium, prolonged hospitalization, discharge to long-term care, immediate postoperative complications, and death. SummaryGeriatric assessment and management has substantial benefits over conventional preoperative assessment alone. This article highlights these advantages and outlines a feasible strategy to incorporate both diseasebased and geriatric-specific assessment and treatment when caring for older surgical patients with cancer.

Preoperative evaluation of the elderly patient

“…In the literature, there are some examples of a brief CGA package that can be routinely applied for the pre-operative assessment of elderly surgical patients. [ 66 67 ]…”

Supportive and palliative care for older adults with cancer

“…Chesney et al . 2 discussed the importance and value of incorporating geriatric assessment into routine surgical oncology practice to enable identification and management of geriatric deficits and promote more accurate risk stratification, with the goal of supporting treatment decision making and care planning.…”