Improving outcomes for older women with gynaecological malignancies

Abstract

The incidence of most gynaecological malignancies rises significantly with increasing age. With an ageing population, the proportion of women over the age of 65 with cancer is expected to rise substantially over the next decade. Unfortunately, survival outcomes are much poorer in older patients and evidence suggests that older women with gynaecological cancers are less likely to receive current standard of care treatment options. Despite this, older women are underrepresented in practice changing clinical studies. The evidence for efficacy and tolerability is therefore extrapolated from a younger; often more fit population and applied to in every day clinical practice to older patients with co-morbidities. There has been significant progress in the development of geriatric assessment in oncology to predict treatment outcomes and tolerability however there is still no clear evidence that undertaking a geriatric assessment improves patient outcomes. Clinical trials focusing on treating older patients are urgently required. In this review, we discuss the evidence for treatment of gynaecological cancers as well as methods of assessing older patients for therapy. Potential biomarkers of ageing are also summarised.

Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group

“…Defining elderly patients based on functional status using geriatric evaluation tools might have been more discriminatory than age alone 46 . Some validated tools exist to predict frailty 47 and toxicity from chemotherapy 43,44,47 , but not for oncologic surgery and chronological age remains a crucial determinant of treatment decisions 48,49 .…”

Efficacy and safety of niraparib as maintenance treatment in older patients (≥ 70 years) with recurrent ovarian cancer: Results from the ENGOT-OV16/NOVA trial

“…Hematologic adverse events (AEs) were classified as AEs of special interest (AESI) in the ENGOT-OV16/NOVA study, and they are of particular concern in the older population due to the reduction of hematopoietic reserves in this population [12]. Here we present a retrospective subanalysis on the safety and efficacy of niraparib in the subgroup of patients aged ≥70 years in the ENGOT-OV16/NOVA trial.…”

Cancer Prevention and Screening for Older Adults: Part 1. Lung, Colorectal, Bladder, and Kidney Cancer

“…9,10 There is increasing evidence that age is not the primary determinant of either an older adult's ability to tolerate or benefit from cancer treatment. 11,12 Frail older adults who have multiple chronic conditions, difficulty maintaining independence, and several geriatric syndromes are at higher risk for adverse outcomes such as mortality or institutionalization and may not have lasting benefits. 13 Comprehensive geriatric assessment or other frailty assessment tools help identify older adults who are more likely to tolerate and benefit from cancer treatment.…”