Management of Cancer in the Older Age Person: An Approach to Complex Medical Decisions

Abstract

The management of cancer in older aged people is becoming a common problem due to the aging of the population. There are many variables determining the complex situation that are interconnected. Some of them can be assessed, such as risk of mortality and risk of treatment complications, but many others are still unknown, such as the course of disease, the host-related factors that influence cancer aggressiveness, and the phenotype heralding risk of permanent treatment-related damage.This article presents a dynamic and personalized approach to older people with cancer based on our experience on aging, cancer, and their biological interactions. Also, novel treatments and management approaches to older individuals, based on their functional age and their social and emotional needs, are thoughtfully explored here. The Oncologist 2017;22:335-342 Implications for Practice: The goal of this article is to suggest a practical approach to complexity, a clinical situation becoming increasingly common with the aging of the population. Beginning with the analysis of two clinical cases, the authors offer an algorithm for approaching cancer in the older person that involves the assessment of life expectancy without cancer, the risk that cancer might compromise a patient's survival, function, or quality of life, and the potential benefits and risks of the treatments based on a clinical evaluation. The authors then review possible laboratory assessment of functional age and the importance of rapid-learning databases in the study of cancer and age.

Optimal cutoff age for predicting prognosis associated with serous epithelial ovarian cancer: what is the best age cutoff?

“…Despite this does not completely explain the tendency for clinicians to treat younger patients more intensively, cancer treatments, especially clinical trials, have been less conducted to this specific frailty population [2627]. Recent studies emphasize the importance of geriatric assessment to ensure the most adapted therapies in elderly patients [2428]. The GINECO and others have suggested that systemic treatments should be based not only on initial clinical evaluation, but also on geriatric assessment to reduce morbidity and toxic mortality and to improve OS [2930].…”

Antineoplastic Therapy Side Effects and Polypharmacy in Older Adults With Cancer

“…Due to these complexities, specific focus and attention is drawn to the physical and functional assessment and supportive care needs of the geriatric oncologic population. 10 Targeted approaches are recommended to improve assessment, intervention, and follow up care specific to the needs of this population. 11,12 A large part of the standard of care approaches for cancer disease management and cancer treatment side effect attenuation relies on pharmacological interventions.…”

Searching for Clinically Relevant Biomarkers in Geriatric Oncology

“…To structure medical decisions in face of uncertainty, information needs to be translated into clinically relevant knowledge and this is the exact advantage that CGA omics data offer, especially if coupled to user-friendly informatics. Recently, clinical cases have served as paradigms to show the interoperability of an algorithm for optimum decision-making in elderly patients with cancer, focusing on the assessment of (i) cancer-free life expectancy, (ii) cancer-related risks on patient survival, function, or quality of life, and (iii) treatment-related risks and benefits [ 54 ]. Notably and as it has been recently showed by a systematic review of systematic reviews with a focus on the use of CGA tools to predict adverse postoperative outcomes [ 55 ], different clinical settings present a range of demands and needs, when daily clinical practice is taken into account.…”