Geriatric oncology research to improve clinical care

Abstract

Summary The incidence of cancer increases with advanced age. The Cancer and Aging Research Group (CARG), in partnership with the National Institute on Aging and National Cancer Institute, held a conference in September of 2010 which summarized the gaps in knowledge in geriatric oncology and recommendations to close these gaps. One recommendation was that the comprehensive geriatric assessment (CGA) should be incorporated within geriatric oncology research. The information from the CGA can be used to stratify patients into risk categories to better predict their tolerance of cancer treatment. CGA can also be used to follow functional consequences from treatment. Other recommendations were to design trials for older adults with study endpoints that address the needs of the older and/or vulnerable adult with cancer and to build better infrastructure to accommodate the needs of older adults to improve their representation in trials. In this review, we utilize a case-based approach to highlight gaps in knowledge regarding the care of older adults with cancer, discuss our current state of knowledge regarding best practice patterns, and identify opportunities for research in geriatric oncology. More evidence regarding the treatment of older patients with cancer is urgently needed given the rapid aging of the population.

Management of Operable Primary Breast Cancer in Older Women

“…Despite recognition that CGA is paramount in this setting, there is no consensus on a recommended assessment tool and how these results should be interpreted [71,75].…”

Lymphadenectomy in elderly/high risk patients: should it be different?

“…Nonetheless, aging is an individualized process, bringing both physiologic and psychosocial changes that can affect tumor biology, decision-making and tolerance for cancer treatment, and ultimately outcomes (18). The prevalence of multiple chronic illnesses in the Unites States is increasing in older adults (19) and it has been observed an even higher prevalence of comorbidity in elderly cancer patients than in an age-matched control group (20,21).…”

“…Moreover, considering improvement in quality of life in developed countries with a subsequent increase of mean life expectancy, and with a discrete part of old population being affected by one or more comorbidities, it seems that a criterion purely based on age would not fit the aim of being a discriminating parameter (18).…”

“…Finally, the role of perioperative chemotherapy cannot be easily evaluated, both because of the administration of different regimens with different schedules and because of the frequent exclusion of elderly high risk patients from oncological trials (18).…”

Complete Response to Full-Dose Sorafenib Treatment in an Elderly HCC Patient: a Case Report

“…However, further information on the use of sorafenib in elderly patients remains warranted. In fact, due to the peculiar and specific characteristics of this patient, it has been suggested that a case-based approach to clinical investigation should be preferred in this setting as long as specific clinical trials are not conducted [9].…”