Managing an Older Adult with Cancer: Considerations for Radiation Oncologists

Abstract

Older adults with cancer present a unique set of management complexities for oncologists and radiation oncologists. Prognosis and resilience to cancer treatments are notably dependent on the presence or risk of “geriatric syndromes,” in addition to cancer stage and histology. Recognition, proper evaluation, and management of these conditions in conjunction with management of the cancer itself are critical and can be accomplished by utilization of various geriatric assessment tools. Here we review principles of the geriatric assessment, common geriatric syndromes, and application of these concepts to multidisciplinary oncologic treatment. Older patients may experience toxicities related to treatments that impact treatment effectiveness, quality of life, treatment-related mortality, and treatment compliance. Treatment-related burdens from radiotherapy are increasingly important considerations and include procedural demands, travel, costs, and temporary or permanent loss of functional independence. An overall approach to delivering radiotherapy to an older cancer patient requires a comprehensive assessment of both physical and nonphysical factors that may impact treatment outcome. Patient and family-centered communication is also an important part of developing a shared understanding of illness and reasonable expectations of treatment.

A review on radiation induced nausea and vomiting: “Current management strategies and prominence of radio sensitizers”

“…Dose adjusted to hypo fractionated radiation therapy finds a better way for treatment implementation. 11 The tumour lethal doses may vary for different cancers 7 and people with variation in 5HT3B genome responds differently to 5hydroxytryptamine 3 receptor antagonist (5-HTRA) therefore genomics must be considered for dosing . 12 However the major goal of RT remains to protect the normal tissues from radiation exposure, preserve quality of life (QOL) of patient, maximise cure rates and minimise the side effects related to therapy.…”

Treatment tolerability and outcomes in elderly patients with head and neck cancer

“…HNSCC treatment course, which typically requires 7 weeks, can be demanding for elderly patients, leading to increased risk of treatment interruptions 30 . Studies in patients with HNSCC have shown that treatment interruptions portend worse tumor control 31,32 and outcomes 33‐35 .…”

Comparing comorbidity scales: Attending physician score versus the Cumulative Illness Rating Scale for Geriatrics

“…Differences in health status are also highly relevant in relation to treatment tolerance. In general, older patients are regarded as more vulnerable than their younger counterparts, with increased risk of chemotoxicity, side effects of radiation therapy, and increased morbidity and mortality after cancer surgery [76][77][78]. However, selected subgroups of fit older patients are known to tolerate and benefit from standard treatment equally to younger patients [79], whereas a large group will have increased risk of treatment complications [80].…”