Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

Abstract

Background: The majority of patients with gastrointestinal (GI) malignancies are older. Recently, it has become evident that elements from a geriatric assessment (GA) are powerful predictors of outcomes such as postoperative morbidity and mortality, length of stay, type of treatment received, and survival across several GI tumor types in older adults. A GA is a systematic evaluation of functional status, comorbidities, polypharmacy, cognition, nutritional status, emotional status, and social support. Methods: A PubMed search was performed in order to identify clinical studies investigating the association between GA and outcomes in patients with GI malignancies. Results: A total of 31 studies were included in this review. For colorectal cancer, the evidence linking GA variables and frailty to negative outcomes is substantial and consistent. The data regarding other GI malignancies is more limited, but generally shows the same findings. Conclusion: Increasing data shows that elements from a GA and frailty are consistently associated with negative short- and long-term treatment outcomes in older patients with GI malignancies. Future studies should investigate the impact of geriatric interventions on outcomes.

Frailty affects prognosis in patients with colorectal cancer: A systematic review and meta-analysis

“…In terms of serious complications, the frail group had a higher incidence than the non-frail group. We also found that frailty has an important impact on the prognosis of patients with colorectal cancer, regardless of frailty screening tools, reported from multiple studies ( 24 – 26 ).…”

Octogenarian patients with colon cancer – postoperative morbidity and mortality are the major challenges

“…It is essential to perform geriatric assessments systematically in the preoperative work-up [ 43 – 45 ], pay attention to the concept of prehabilitation [ 46 ], and increase focus on patient preferences [ 47 ]. Recent reports have demonstrated the value of a geriatric assessment in summarizing the patient's degree of frailty and predicting postoperative morbidity and mortality for older patients with colon cancer [ 48 ]. The Society for Geriatric Oncology has recommended these assessments for all patients with cancer that are over 70 years of age [ 49 ].…”

Challenges in the treatment of gastric cancer in the older patient

“…A meta-analysis of 6 studies including 1,037 participants found that comorbidity, polypharmacy and activities of daily living (ADL) dependency components to the CGA were predictive factors for postoperative complications in gastrointestinal cancer patients (with cognition, nutritional status, depression and instrumental ADLs showing no conclusive relationship) (26). There have been limited studies evaluating the role of a GA in predicting outcomes specifically in gastro-oesophageal cancers, with most small retrospective cohort studies (27). The largest of these reviewed279 patients, in a single US centre, who had undergone gastrectomy for adenocarcinoma and in whom a GA had been performed within 30 days of surgery.…”