International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

Abstract

A B S T R A C T PurposeTo update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. MethodsSIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment-related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. ResultsGA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. ConclusionThere is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

“…Conservative care has become an accepted alternative for dialysis to discuss with selected patients with ESRD who may not benefit from dialysis (7). There is general consensus that chronologic age is not a useful selection criterion here, because ageing is a heterogeneous process (8). However, a systematic and evidence-based way to guide treatment decisions is currently lacking.…”

“…A GA is defined as a multidimensional, interdisciplinary diagnostic process focusing on determining an older person's medical, psychosocial, and functional capabilities to develop a coordinated and integrated plan for treatment and long-term follow-up (10). Such a GA has been shown to successfully identify patients at risk for poor outcome in geriatric oncology (11) and improve outcomes in older patients admitted to the emergency department (9), and it is increasingly recommended as being the standard of care in the treatment decisionmaking process in elderly patients (8). The aim of this review is to give an overview of all currently available evidence regarding the relation of geriatric impairments and the accumulation of impairment across these domains at initiation of dialysis with mortality and dialysis-related complications.…”

“…In other research fields, a systematic geriatric assessment (GA) was shown to fill this knowledge gap (8,9). A GA is defined as a multidimensional, interdisciplinary diagnostic process focusing on determining an older person's medical, psychosocial, and functional capabilities to develop a coordinated and integrated plan for treatment and long-term follow-up (10).…”

Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico

“…Ademais, o tratamento pode acarretar mais efeitos colaterais em idosos do que em pacientes jovens, e essa toxicidade pode deteriorar a QVRS desses pacientes, colocando em discussão a melhor opção terapêutica. 2,3,5 Ainda não existe um instrumento padronizado para avaliar QVRS em pacientes idosos com câncer. O European Organization for Research and Treatment of Cancer Quality of Life Questionnaire "core" 30 item (EORTC QLQ-C30) é um questionário câncer-específico, multidimensional e aplicável a diferentes culturas.…”

“…14 A identificação das particularidades dos idosos com câncer submetidos a quimioterapia antineoplásica faz-se necessária por meio de estudos que avaliem a qualidade de vida e, assim, melhorem a abordagem terapêutica desse subgrupo de pacientes. 5,12 Objetivou-se, aqui, avaliar os efeitos da quimioterapia antineoplásica na qualidade de vida relacionada à saúde (QVRS) de idosos. As informações sociodemográficas e clínicas foram obtidas por meio de entrevistas registradas em um questionário elaborado para a presente pesquisa e mediante consulta ao prontuário.…”