Frailty: A Common Pathway in Aging and Cancer

Balducci, Lodovico

doi:10.1159/000343586

Cited by 38 publications

(24 citation statements)

References 44 publications

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“…Today, the term "frailty" is no longer confined within the borders of the geriatrics and gerontology world. From cardiology [14] to infectious disease medicine [15], from oncology [16] to anesthesiology [17], frailty has become a condition of wide interest both in clinical and research settings. Some healthcare systems have even implemented special economical bonuses to award those clinical services that follow the principles of the comprehensive geriatric assessment for the management of frail elders.…”

Section: Geriatric Practice In Different Medical Specialtiesmentioning

confidence: 99%

The geriatric management of frailty as paradigm of “The end of the disease era”

Cesari

Marzetti

Thiem

et al. 2016

European Journal of Internal Medicine

170

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The sustainability of healthcare systems worldwide is threatened by the absolute and relative increase in the number of older persons. The traditional models of care (largely based on a disease-centered approach) are inadequate for a clinical world dominated by older individuals with multiple (chronic) comorbidities and mutually interacting syndromes. There is the need to shift the center of the medical intervention from the disease to the biological age of the individual. Thus, multiple medical specialties have started looking with some interest at concepts of geriatric medicine in order to better face the increased complexity (due to age-related conditions) of their average patient. In this scenario, special interest has been given to frailty, a condition characterized by the reduction of the individual's homeostatic reserves and increased vulnerability to stressors. Frailty may indeed represent the fulcrum to lever for reshaping the healthcare systems in order to make them more responsive to new clinical needs. However, the dissemination of the frailty concept across medical specialties requires a parallel and careful consideration around the currently undervalued role of geriatricians in our daily practice.

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Section: Geriatric Practice In Different Medical Specialtiesmentioning

confidence: 99%

The geriatric management of frailty as paradigm of “The end of the disease era”

Cesari

Marzetti

Thiem

et al. 2016

European Journal of Internal Medicine

170

View full text Add to dashboard Cite

show abstract

“…Some older patients may be as fit as younger patients, others may have a marginal decline in physiologic reserve, and yet others may be frail. 6 It is essential to identify those patients who are fit and potentially more resilient because they are more likely to benefit from standard treatment. 7 Fit older adults have few comorbidities, no functional deficits, and few (if any) geriatric syndromes such as falls or dementia.…”

Section: Introductionmentioning

confidence: 99%

How We Care for an Older Patient With Cancer

Shahrokni

Kim

Bosl

et al. 2017

JOP

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As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient's needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient's preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.

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“…The accepted definition of frailty encompasses individuals at increased risk of mortality, disability, and hospitalization over a 10‐year period. In the cardiovascular health study that included 8,500 persons aged 65 years and older, a frailty phenotype (Panel 1) has been defined . The role of this phenotype in the management of cancer has not been fully established.…”

Section: Analysis Of the Clinical Casesmentioning

confidence: 99%

Management of Cancer in the Older Age Person: An Approach to Complex Medical Decisions

et al. 2017

Self Cite

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The management of cancer in older aged people is becoming a common problem due to the aging of the population. There are many variables determining the complex situation that are interconnected. Some of them can be assessed, such as risk of mortality and risk of treatment complications, but many others are still unknown, such as the course of disease, the host-related factors that influence cancer aggressiveness, and the phenotype heralding risk of permanent treatment-related damage.This article presents a dynamic and personalized approach to older people with cancer based on our experience on aging, cancer, and their biological interactions. Also, novel treatments and management approaches to older individuals, based on their functional age and their social and emotional needs, are thoughtfully explored here. The Oncologist 2017;22:335-342 Implications for Practice: The goal of this article is to suggest a practical approach to complexity, a clinical situation becoming increasingly common with the aging of the population. Beginning with the analysis of two clinical cases, the authors offer an algorithm for approaching cancer in the older person that involves the assessment of life expectancy without cancer, the risk that cancer might compromise a patient's survival, function, or quality of life, and the potential benefits and risks of the treatments based on a clinical evaluation. The authors then review possible laboratory assessment of functional age and the importance of rapid-learning databases in the study of cancer and age.

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Frailty: A Common Pathway in Aging and Cancer

Cited by 38 publications

References 44 publications

The geriatric management of frailty as paradigm of “The end of the disease era”

The geriatric management of frailty as paradigm of “The end of the disease era”

How We Care for an Older Patient With Cancer

Management of Cancer in the Older Age Person: An Approach to Complex Medical Decisions

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