Oncogeriatrics (part 7.). Geriatric assessment for older patients with cancer

Abstract

The geriatric assessment (GA) is defined as a multidimensional, interdisciplinary diagnostic process focusing on determining an older person's medical, psychosocial, and functional capabilities that are not identified by routine evaluation. There is more and more data on the benefits of the GA in the evaluation and management process of older patients with cancer. It allows for the development of an individual cancer treatment plan resulting in less postoperative complications, reduced treatment toxicity, improved quality of life and very often without compromising survival. However, the relationship between specific domains of the GA and post-treatment medical outcomes, functional status and quality of life remains unknown. Moreover, there is still no consensus over what the "golden standard" GA should look like, which tools should be included and what cutoff should be used. This is still an active area of research. However, there is no doubt that understanding the health status of an older patient with cancer should be as important as cancer staging and tumour biology.

Hepatocellular cancer and colorectal liver metastasis treatment in the older population

“…Many older adults have unidentified, uncommunicated, and therefore unaddressed aging-related conditions that are associated with poorer outcomes. As a result, the Comprehensive Geriatric Assessment (CGA) was introduced to help determine the primary status of the older patient, to diagnose frailty syndrome, and to identify how to optimize the patient's condition before the start of treatment [14][15][16]. Therefore, more and more organisations, including the International Society of Geriatric Oncology, the National Comprehensive Network, the European Organisation for the Research and Treatment of Cancer, the American College of Surgeons National Surgical Quality Improvement Program, and the American Geriatric Society have called for the routine use of the Geriatric Assessment.…”

Pancreatoduodenectomy due to cancer in the older population

“…Many older adults have unidentified, uncommunicated, and therefore unaddressed aging-related conditions that are associated with morbidity and early mortality. Therefore, the Comprehensive Geriatric Assessment (CGA) was introduced to help determine the primary status of the older patient, to diagnose frailty syndrome and to identify how to optimise the patient's condition before the start of treatment [7][8][9][10].…”

“…A tailored approach should be discussed in a geriatric multidisciplinary team meeting [9]. It is also possible to determine the severity of the frailty using the cumulative deficit model for the CGA [10]. Such assessments may guide treatment decisions through evaluations of the balance of benefits and risk-factors associated with performing or omitting specific oncologic interventions.…”

Treatment of gastric cancer in the older population

“…A tailored approach should be discussed in a geriatric multidisciplinary team meeting [9]. It is also possible to determine the severity of the frailty using a cumulative deficit model for the CGA [10].…”