Onco-Geriatric Approach for the Management of Older Patients with Cancer

Cesari, Matteo; Colloca, Giuseppe; Cerullo, Francesco; Ferrini, Alessandro; Testa, Antonia Carla; Foti, E; Ciaburri, Michele; Scambia, Giovanni; Bernabei, Roberto; Gambassi, Giovanni

doi:10.1016/j.jamda.2010.06.008

Cited by 25 publications

(10 citation statements)

References 68 publications

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“…This interaction is of particular interest in the case of those with a history of cancer. Currently, the clinical application of the concept of frailty in oncology consists of the identification of frail and fit individuals as part of the decision-making process for their treatment, with preliminary results of such efforts particularly promising [7–9]. However, little is known about how the past medical history of cancer (for example, cancer that occurred in early adulthood) and frailty among survivors at advanced age are related.…”

Section: Introductionmentioning

confidence: 99%

Cancer and frailty in older adults: a nested case-control study of the Mexican Health and Aging Study

et al. 2016

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Purpose Understanding how the convergence between chronic and complex diseases—such as cancer—and emerging conditions of older adults—such as frailty—takes place would help in halting the path that leads to disability in this age group. The objective of this manuscript is to describe the association between a past medical history of cancer and frailty in Mexican older adults. Methods This is a nested in cohort case-control study of the Mexican Health and Aging Study. Frailty was categorized by developing a 55-item frailty index that was also used to define cases in two ways: incident frailty (incident >0.25 frailty index score) and worsening frailty (negative residuals from a regression between 2001 and 2012 frailty index scores). Exposition was defined as self-report of cancer between 2001 and 2012. Older adults with a cancer history were further divided into recently diagnosed (<10 years) and remotely diagnosed (>10 years from the initial diagnosis). Odds ratios were estimated by fitting a logistic regression adjusted for confounding variables. Results Out of a total of 8022 older adults with a mean age of 70.6 years, the prevalence of a past medical history of cancer was 3.6 % (n = 288). Among these participants, 45.1 % had been diagnosed with cancer more than 10 years previously. A higher risk of incident frailty compared to controls [odds ratio (OR) 1.53 (95 % confidence interval (CI) 1.04–2.26, p = 0.03); adjusted model OR 1.74 (95 % CI 1.15–2.61, p = 0.008)] was found in the group with a recent cancer diagnosis. Also, an inverse association between a remote cancer diagnosis and worsening frailty was found [OR = 0.56 (95 % CI 0.39–0.8), p = 0.002; adjusted model OR 0.61 (95 % CI 0.38–0.99, p = 0.046)]. Conclusions Cancer is associated with a higher frailty index, with a potential relevant role of the time that has elapsed since the cancer diagnosis. Implications for cancer survivors Cancer survivors may be more likely to develop frailty or worsening of the health status at an older age. This relationship seems especially evident among individuals with a recent oncological diagnosis. Health professionals in charge of older adult care should be aware of this association in order to improve outcomes of older adults who survived cancer.

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Section: Introductionmentioning

confidence: 99%

Cancer and frailty in older adults: a nested case-control study of the Mexican Health and Aging Study

et al. 2016

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“…1) the creation of geriatric oncology units within selected general oncology hospitals [62,63] 2) the development of geriatric consultation teams available for patients who remain under the supervision of their treating oncologists [51,64] 3) the third model occurs in settings where geriatric expertise is not nearby (e.g., standalone cancer centers without geriatric departments or private practice oncology clinics). In these settings, CGA can be performed to identify high-risk patients who could be referred to geriatricians outside of the cancer center (consultation or even electronic consulting) or to a multidisciplinary team within the cancer center [65].…”

Section: Discussionmentioning

confidence: 99%

Integrating Oncogeriatric Tools into the Management of Chronic Lymphocytic Leukemia: Current State of the Art and Challenges for the Future

Merli¹,

Mammi²,

Ilariucci³

2015

Curr Oncol Rep

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Although the achievement of deep and long lasting remissions is a realistic goal of therapy in the fit patient with chronic lymphocytic leukemia (CLL), this disease typically affects elderly patients who also show one or more concomitant pathological conditions or functional limitations that have an additive effects on the reduction of patient's life expectancy and represent major limitations in the adoption of standard therapies. In these unfit but typical patients with CLL, the goals of treatment may vary from achieving good remissions without severe toxicity to simple palliation. Differently from the past when the definition of patient medical status was mainly based on age and was left to the subjective assessment of the physician, today there are several tools to define in a standardized, reproducible, and multidimensional way the initial patient assessment and to plan treatment goals in an objective way. In this review, an overview of the current approaches to the definition of the medical fitness of the patient is provided along with some practical suggestions to integrate these tools in the clinical approach to elderly patients with CLL.

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“…Geriatric oncology does not exist in many radiotherapy departments at the current time, but there are many international models to use as exemplars as to how it may be implemented in clinical practice [118][119][120]. One major challenge is that there is a notable shortage of geriatricians worldwide [121].…”

Section: Implementation In Clinical Practicementioning

confidence: 99%

Personalised treatment for older adults with cancer: The role of frailty assessment

O’Donovan

Leech

2020

Technical Innovations & Patient Support in Radiation Oncolo

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It is widely accepted in clinical practice that chronological age is a poor predictor of treatment tolerance and outcomes in older adults with cancer. Intrinsic vulnerability is more a function of underlying frailty, rather than chronological age. Frailty is a state of increased vulnerability to stressors, such as cancer and its treatment, which can lead to adverse health outcomes for patients. Capturing this heterogeneity in reserve capacity is the cornerstone of management in geriatricmedicine, but remains poorly understood or adopted in radiation oncology. A two-step approach, using a shorter screening tool, followed by full assessment for those who need it, is the mostresourceful way of implementing frailty assessment in radiotherapy departments. It is important for radiation oncology professionals to identify frailty and to use this information in multidisciplinary decision making in order to develop a personalised radiotherapy approach for the older person. There are many ways we can effectively use this information, such as considering treatment fractionation schedules that would limit the burden of travel for those with social frailty, or reviewing the range of modalities at our disposal, which might limit toxicity in the older person at high risk of deterioration during treatment. Frailty assessment is not carried out in many radiotherapy departments presently, but there are many international models to use as exemplars as to how it may be implemented in clinical practice. There are many opportunities for further research and role development in this field at the current time.

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Onco-Geriatric Approach for the Management of Older Patients with Cancer

Cited by 25 publications

References 68 publications

Cancer and frailty in older adults: a nested case-control study of the Mexican Health and Aging Study

Cancer and frailty in older adults: a nested case-control study of the Mexican Health and Aging Study

Integrating Oncogeriatric Tools into the Management of Chronic Lymphocytic Leukemia: Current State of the Art and Challenges for the Future

Personalised treatment for older adults with cancer: The role of frailty assessment

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