How We Care for an Older Patient With Cancer

Abstract

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.

Traumatic brain injury - the effects of patient age on treatment intensity and mortality

“…During the last 30 years there has been a signi cant change in attitude to treating older patients for severe medical conditions, e.g. in cardiology, cancer, and degenerative spine conditions (52)(53)(54)(55). Increased knowledge and improvements during the last decades in anaesthesiology, intensive care medicine, neurosurgery, advanced surgical techniques, and rehabilitation give us the opportunity to push the previous limits of TBI treatment (56)(57)(58)(59).…”

Protocol for a systematic review of self-management interventions for older adults living with cancer

“…Our population of focus is older adults (≥ 65 years) diagnosed with cancer of any tumour type (solid tumours and haematological malignancies) at stages 1-3. We are excluding interventions targeting those with stage 4 cancer or advanced cancer, as interventions targeting stage 4 cancer with an older adult population may be more geared towards palliation and end of life strategies [18]. Generating knowledge regarding older adults with cancer is important, as ageing is identified as the most important risk factor for cancer [19], and there is limited (but growing) evidence supporting the care of older adults with cancer [20].…”

Geriatric Assessment in Oncology: G8 Screening Tool Validation and Reliability Study

“…To include CGA in routine care, which is a standard of care in oncology practice, older adults diagnosed with cancer must be screened to check whether full CGA is required or not. [18,19] Given the time and resource barriers related to CGA, the use of geriatric screening tool become prominent; [5,20,21] multiple screening tools, such as abbreviated Comprehensive Geriatric Assessment, [22] Cancer-Specific Geriatric Assessment instrument, [23] Vulnerable Elderly Survey-13, [24] Fried Frailty Criteria, [5,21] and Geriatrics 8 (G8). [25] Although the choice of the tool depends on clinical resources, G8 was recommended by SIOG with its highest sensitivity.…”