Treatment Strategies and Practice Guidelines in Geriatric Oncology

US Oncology Review, 2005;1(1):12-6

Cancer is largely a disease of elderly people (see Figure 1), while its risk increases significantly with age (see Figure 2). Moreover, the Western population is aging rapidly (see Figure 3). Although 60% of new cancer cases and over 70% of cancer deaths occur in patients aged 65 and older in Europe, standard cancer treatment strategies have mostly been validated in younger adults. Many trials have excluded elderly patients (see Figure 4).

Aging brings with it a progressive but extremely uneven decline of functional reserves and a reduction of adaptability; therefore, many treatments need to be dapted to this reality. The challenge of the appropriate management of the increasing number of elderly cancer patients, and its impact on the rising costs of medical and social care, has been poorly anticipated. This demographic trend has led to the emergence of a new medical discipline, geriatric oncology, and to the development worldwide of geriatric oncology programmes dedicated to the management of elderly cancer patients.

Due to increased specialisation, oncologists and organ specialists are increasingly directed toward treatment of one tumor type and disease. However, older patients cannot be managed in the same way as their younger counterparts due to concomitant and possibly multiple medical problems.The management of elderly cancer patients requires multidisciplinary skill and, ideally, close relationships between oncologists and geriatricians. Geriatricians have studied the highly heterogeneous process of aging, and have elaborated a comprehensive multidisciplinary assessment tool, comprehensive geriatric assessment (CGA), in which all aspects of older individuals are considered and resources and abilities are listed.

Crucial elements of CGA are performance status, functionality, nutritional condition, co-morbidity, polymedication, social situation, cognitive dysfunction, and depression. This CGA process has previously demonstrated its ability to improve survival and quality of life and reduce costs for the elderly community. Based on this appraisal, physicians can draw and coordinate an effective care program, providing interventions tailored to each individual’s problems.

References:
  1. Aapro M, Kohne C H, Cohen H J, Extermann M,“Never too old? Age should not be a barrier to enrollment in cancer clinical trials”, Oncologist (2005);10: pp. 198–204.
  2. Audisio R et al.,“The surgical management of elderly cancer patients: recommendations of the SIOG surgical task force”, Eur. J. Cancer (2004);40: pp. 926–938.
  3. Extermann M, Aapro M, Bernabei R et al., “Use of Comprehensive Geriatric Assessment in older cancer patients. Recommendations from the Task Force on CGA of the International Society of Geriatric Oncology (SIOG)”, Critical Rev. Oncol. Hematol. (2005);55: pp. 241–252.
  4. Repetto L, Biganzoli L, Koehne C H et al., “EORTC Cancer in the Elderly Task Force guidelines for the use of colonystimulating factors in elderly patients with cancer”, Eur. J. Cancer (2003);48: pp. 227–237.
  5. Repetto L, Fratino L,Audisio R A et al.,“Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study”, J. Clin. Oncol. (2002);20: pp. 494–502.
  6. Reuben D B, Siu A L,“An objective measure of physical function of elderly outpatients.The Physical Performance Test”, J.Am. Geriatr. Soc.(1990);38: pp. 1,105–1,112.
  7. Terret C, Zulian G, Droz J P, “Statements on the interdependence between the oncologist and the geriatrician in geriatric oncology”, Crit. Rev. Oncol. Hematol. (2004);52: pp. 127–133.
  8. Wildiers H, Highley M S, de Bruijn E A, van Oosterom A T,“The pharmacology of anticancer drugs in the elderly population”, Clin. Pharmacokinet (2003);42(14): pp. 1,213–1,242.
  9. Yancik R, Ries L A, “Cancer in older persons: an international issue in an aging world”, Semin. Oncol. (2004);31: pp. 128–136.
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