Personalised treatment for older adults with cancer: The role of frailty assessment

Abstract

It is widely accepted in clinical practice that chronological age is a poor predictor of treatment tolerance and outcomes in older adults with cancer. Intrinsic vulnerability is more a function of underlying frailty, rather than chronological age. Frailty is a state of increased vulnerability to stressors, such as cancer and its treatment, which can lead to adverse health outcomes for patients. Capturing this heterogeneity in reserve capacity is the cornerstone of management in geriatricmedicine, but remains poorly understood or adopted in radiation oncology. A two-step approach, using a shorter screening tool, followed by full assessment for those who need it, is the mostresourceful way of implementing frailty assessment in radiotherapy departments. It is important for radiation oncology professionals to identify frailty and to use this information in multidisciplinary decision making in order to develop a personalised radiotherapy approach for the older person. There are many ways we can effectively use this information, such as considering treatment fractionation schedules that would limit the burden of travel for those with social frailty, or reviewing the range of modalities at our disposal, which might limit toxicity in the older person at high risk of deterioration during treatment. Frailty assessment is not carried out in many radiotherapy departments presently, but there are many international models to use as exemplars as to how it may be implemented in clinical practice. There are many opportunities for further research and role development in this field at the current time.

Outcomes of Geriatric Patients with Hepatocellular Carcinoma

“…Older patients are more likely to be strictly selected for aggressive treatments probably because of poor general condition, preexisting comorbidities, increased toxicity during chemotherapy [ 13 ], reluctance of clinicians/patients to offer/undergo surgery [ 4 ], longer hospital stay, and higher in-hospital mortality rates [ 14 ]. Identifiable comorbidities and frailty changes due to aging can limit a patient’s ability to tolerate cancer therapy [ 15 ].…”

The Prognostic Value of Comprehensive Geriatric Assessment on the Management of Older Patients With Small Cell Lung Cancer

“…CGA in older cancer patients indicates previously unknown geriatric problems in many patients (up to 50%) and may alter treatment decisions in 10-20% of patients [19]. Among the domains of CGA, limitations in cognition, nutrition, function, and comorbidities have been shown to be important factors in diminishing OS in older cancer patients in several studies [20][21][22]. It has also been shown that specialized geriatric intervention for older cancer patients signi cantly improved OS and facilitated a return to their own home compared to conventional care.…”

Treatment of Metastatic Gastrointestinal Stromal Tumors (GIST): A Focus on Older Patients

“…The gold standard of clinical assessment of frailty is the CGA. As this is a time-consuming tool and requires some training, screening tools such as the clinical frailty scale, the frailty phenotype, or the frailty index can be used as a preliminary step to select patients for CGA [ 120 ].…”