Get Adobe Flash player
Geriatric Oncology Role of the Comprehensive Geriatric Assessment in an Elderly Consultation MJ Molina-Garrido, MD, PhD, 1 Carmen Guillén-Ponce, MD, PhD, 2 Nieves Bravo Delgado, MD, PhD 3 and Antonia Mora-Rufete MD, PhD 4 1. Elderly Cancer Unit, Medical Oncology Section, Hospital General Virgen de la Luz, Cuenca, Spain; 2. Medical Oncology Department, Hospital General Universitario Ramón y Cajal, Madrid, Spain; 3. Cardiology Department, Hospital General Virgen de la Luz, Cuenca, Spain; 4. Internal Medicine Department, Hospital General Universitario de Elche, Alicante, Spain Abstract The incidence of cancer increases dramatically with age and is reported to be 12 to 36 times higher in patients 65 years or older compared with those aged 25 to 44 years. The challenge for oncologists is to determine the optimum treatment for elderly patients. The Comprehensive Geriatric Assessment (CGA) is the main tool to take decisions in elderly patients diagnosed with cancer. And many screening tools have been tested to select which patients should be taken or not a complete CGA. Matters that influence geriatric assessment in the oncologic population will be highlighted in this article. Keywords Comprehensive geriatric assessment, frailty, cancer, elderly, chemotherapy, toxicity, aging, Oncogeriatrics Disclosure: The authors have no conflicts if interest to declare. Received: August 30, 2013 Accepted: September 9, 2013 Citation: Oncology & Hematology Review (US), 2013;9(2):138–141 Correspondence: Maria-Jose Molina-Garrido, MD, PhD, Elderly Cancer Unit, Medical Oncology Department, Hospital Virgen de la Luz in, Calle de la Hermandad Donantes de Sangre, Cuenca, 16002, Spain. E: mjmolinagarrido@hotmail.com An increasing proportion of elderly people attend medical oncology consultations in which many questions about appropriate treatment will be raised by the oncologist. The balance between treatment benefits (in terms of further life expectancy of the elderly) and risks (hematologic and nonhematologic toxicity, functional impairment, and even death) will be discussed. In many cases, the treatment of elderly cancer is suboptimal, especially because of concerns of inducing severe toxicity in this population. Age alone should not be used as the only factor in making decisions. We must also consider other factors, such as comorbidity, functional status of the patient, cognitive and mood status, nutritional status, and social risk. In order to evaluate each of these factors, it is crucial to perform a Comprehensive Geriatric Assessment (CGA) as well as a specific training in Oncogeriatrics, which should be mandatory for Oncologists. In this article, we will briefly describe the current situation in Oncogeriatrics, the peculiarities of the treatment of elderly patients, and which tools are valuable to comprehensively assess the elderly patient, with the intention of getting optimal treatment in terms of maximum efficacy and minimal toxicity. Epidemiology of Cancer in the Elderly In the US and Europe, the elderly account for 13–15 % of the total population 1 (old age is defined as 65 years or older). However, this broad definition cannot distinguish between patients in different stages of aging. Sometimes it is useful to consider three different stages: the old–young (the young–old), between 65 and 70 years; the elderly elderly (the old–old), between 75 and 84 years; and older-elderly (the oldest–old), i.e. 85 years or more. 138 Currently, 50  % of malignant tumors occur in people 65 years or older. The final outcome data on survival and epidemiology (SEER [Surveillance, Epidemiology and End Results]) of the National Cancer Institute suggests that people more than 64 years are 11 times more likely to develop cancer than people between 25 and 44 years and this risk is two to three times higher than in those between 45 and 64 years. As a result, more than two-thirds of patients with certain cancers (colon, rectum, stomach, pancreas, bladder) are 65 years old or more, and over 50 % of all hematologic malignancies are diagnosed in the elderly. 2,3 If current trends of population growth continue, in 2020, approximately 60 % of all cancers will affect the elderly. 4 The annual crude incidence of cancer in Europe is 338 per 100,000 inhabitants in Eastern Europe, and 447 per 100,000 population in Western Europe 5 and this incidence increases with age. Due to population growth, the management of elderly cancer patients represents a challenge for the medical community. Life expectancy has increased in both men and women. It is estimated that life expectancy can exceed 90 years in women in industrialized countries. 6 Approximately 70 % of deaths attributed to cancer occur in people 65 years or older. It is clear that 35  % of cancer deaths in men and 46  % of cancer deaths in women occur after age 74. Cancer-specific mortality is still increasing according to age, and despite considerable progress in the management and treatment of cancer in the general population, mortality in the elderly has increased by 15–20 % between 1970 and 1994. 7 In Europe, the 5-year © Tou c h M E d ica l ME d ia 2013