Challenges in Geriatric Oncology—A Surgeon’s Perspective

Abstract

As our global population ages, we will see more cancer diagnoses in older adults. Surgery is an important treatment modality for solid tumours, forming the majority of all cancers. However, the management of older adults with cancer can be more complex compared to their younger counterparts. This narrative review will outline the current challenges facing older adults with cancer and potential solutions. The challenges facing older adults with cancer are complex and include lack of high-level clinical trials targeting older adults and selection of the right patient for surgery. This may be standard surgical treatment, minimally invasive surgery or alternative therapies (no surgery) which can be local or systemic. The next challenge is to identify the individual patient’s vulnerabilities to allow them to be maximally optimised for treatment. Prehabilitation has been shown to be of benefit in some cancer settings but uniform guidance across all surgical specialties is required. Greater awareness of geriatric conditions amongst surgical oncologists and integration of geriatric assessment into a surgical clinic are potential solutions. Enhanced recovery programmes tailored to older adults could reduce postoperative functional decline. Ultimately, the greatest challenge an older adult with cancer may face is the mindset of their treating clinicians—a shared care approach between surgical oncologists and geriatricians is required.

Breast Cancer in Geriatric Patients: Current Landscape and Future Prospects

“…With modern surgery and anesthesia, breast surgeries are considered safe and is usually associated with very low complication rates regardless of extent of surgery; breast-conserving (BCS) or mastectomy. 11 , 12 Omitting surgical resection in such patients, can have a negative impact on treatment outcomes regardless of age, tumor stage, hormone receptor and human epidermal growth factor receptor-2 (HER2) status. 13 , 14 In a prospective multicenter study in UK that included women aged 70 or older with primary operable invasive breast cancer (T1-4N0-2M0), researchers found that age, frailty and comorbidities affected decision for mastectomy and axillary dissection.…”

Learning to Care for the Older People: An Urgent Need in the Daily Practice of Oncologists

“…In recent years, many researchers have, thus, defined recommendations and guidelines that highlight some key issues in the management of older patients who undergo surgery [ 20 ], as well as in the treatment of advanced diseases, both for cancers typical of this age, such as those of the prostate [ 21 ], and for those with more widespread incidence and mortality, such as those of the lung [ 22 , 23 ], colon [ 7 ], gastric [ 24 ], and breast [ 25 ].…”