Multidimensional geriatric evaluation in elderly cancer patients: a practical approach (original) (raw)
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Comprehensive Geriatric Assessment in the Older Adult with Cancer: A Review
European Urology Focus, 2017
Context: The number of older adults with cancer is expected to increase rapidly in the upcoming decades. Aging is heterogeneous and chronological age is often not reflective of biological age. A comprehensive geriatric assessment (CGA) is an in-depth assessment of multiple domains of health that results in better assessment of a patient's overall health and fitness and allows directed intervention to improve patient outcomes. Objective: To review the value of CGA for older adults with cancer, CGA composition and tools that can be utilized, and the feasibility of including CGA in oncologic practice. Evidence acquisition: The currently available evidence on CGA for older adults with cancer was reviewed. Evidence synthesis: A CGA can highlight unidentified health problems and identify patients at higher risk of mortality, functional decline, surgical complications, chemotherapy intolerance, and chemotherapy toxicity. It has been shown that CGA is feasible in the oncology clinic, but geriatric screening tools may be useful to specifically identify patients who would benefit from a full CGA. Conclusions: CGA is feasible and can identify patients at higher risk of adverse events such as mortality, functional decline, surgical complications, and chemotherapy toxicity. Clinicians should consider incorporating CGA when assessing and caring for older adults with cancer. Patient summary: In this report, we review the benefits of a comprehensive geriatric assessment (CGA), a detailed in-depth assessment that identifies health problems not typically identified during routine assessments, for older adults with cancer. We describe the different domains of the CGA and suggest tools to utilize, as well as ways to incorporate CGA into the cancer care setting.
Journal of Clinical Oncology, 2014
To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG 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. Results GA 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. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.
Assessment of older patients in oncology
2012
Cancer is a disease of the elderly with almost 60% of new cancer diagnoses and 70% of cancer deaths occurring in patients over 65 years of age. With population ageing the prevalence of cancer in older patients is expected to rise even further in the future. Choosing the optimal treatment for older cancer patients is challenging since ageing is often related with physiological changes and organ function impairment that can alter anticancer treatment tolerance and efficacy. Ageing is a highly individualized process and chronological age alone cannot accurately define the functional reserve and life expectancy of an individual. A number of methods have been developed for a thorough assessment of older patients in order to help treatment decisions. The comprehensive geriatric assessment of older patients in oncology is presented in this article.
Use of comprehensive geriatric assessment in older cancer patients
Critical Reviews in Oncology/Hematology, 2005
Background: As more and more cancers occur in elderly people, oncologists are increasingly confronted with the necessity of integrating geriatric parameters in the treatment of their patients. Methods: The International Society of Geriatric Oncology (SIOG) created a task force to review the evidence on the use of a comprehensive geriatric assessment (CGA) in cancer patients. A systematic review of the evidence was conducted. Results: Several biological and clinical correlates of aging have been identified. Their relative weight and clinical usefulness is still poorly defined. There is strong evidence that a CGA detects many problems missed by a regular assessment in general geriatric and in cancer patients. There is also strong evidence that a CGA improves function and reduces hospitalization in the elderly. There is heterogeneous evidence that it improves survival and that it is cost-effective. There is corroborative evidence from a few studies conducted in cancer patients. Screening tools exist and were successfully used in settings such as the emergency room, but globally were poorly tested. The article contains recommendations for the use of CGA in research and clinical care for older cancer patients. Conclusions: A CGA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival. The task force cannot recommend any specific tool or approach above others at this point and general geriatric experience should be used.
Geriatric oncology: questions, answers and guidelines
memo - Magazine of European Medical Oncology, 2020
Summary Background With the aging of populations, the number of elderly persons with cancer will increase. Due to the high individuality of elderly persons and their varying patterns of resources and disabilities, cancer treatment for elderly cancer patients needs to be individually adapted. To achieve this, geriatric medicine has established the comprehensive geriatric assessment (CGA). This short review presents the evidence of feasibility and impact of CGA on cancer treatment in elderly patients, as recommended by the American Society of Clinical Oncology (ASCO) in 2018. Methods A systematic review of the literature and a Delphi Consensus with a panel of experts cooperated to compile the evidence for choosing the most adequate treatment for elderly cancer patients. Results There is evidence that CGA makes it possible to predict the occurrence of complications of chemotherapy and of health deterioration, as well as death within 1 year. Conclusion The ASCO has recognized the optimi...
Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment
Clinical interventions in aging, 2014
Cancer is common in older patients, who raise specific treatment challenges due to aging-related, organ-specific physiologic changes and the presence in most cases of comorbidities capable of affecting treatment tolerance and outcomes. Identifying comorbid conditions and physiologic changes due to aging allows oncologists to better assess the risk/benefit ratio and to adjust the treatment accordingly. Conducting a Comprehensive Geriatric Assessment (CGA) is one approach developed for this purpose. We reviewed the evidence on the usefulness of CGA for assessing health problems and predicting cancer treatment outcomes, functional decline, morbidity, and mortality in older patients with solid malignancies. We searched Medline for articles published in English between January 1, 2000 and April 14, 2014, and reporting prospective observational or interventional studies of CGA feasibility or effectiveness in patients aged ≥65 years with solid malignancies. We identified studies with at le...
Comprehensive geriatric assessment in older patients with cancer: Two steps forward?
Journal of Geriatric Oncology, 2013
Multiple organizations, including the International Society of Geriatric Oncology and the National Comprehensive Cancer Network, have recommended that all older adults (usually defined as age 70 or older) with cancer undergo a comprehensive geriatric assessment (CGA) at the time of diagnosis and/or prior to treatment decision-making. 1,2 CGA has three key goals in the oncology setting:
Utilization of comprehensive geriatric assessment in cancer patients
Critical Reviews in Oncology Hematology, 2004
A growing and diverse aging population, recent advances in research on aging and cancer, and the fact that a disproportional burden of cancer still occurs in people aged 65 years and older have generated great interest in delivering better cancer care for older adults. This is particularly true as more survivors of cancer live to experience cancer as a chronic disease. Cancer and its treatment precipitate classic geriatric syndromes such as falls, malnutrition, delirium, and urinary incontinence. Comprehensive Geriatric Assessment (CGA), by taking all patient's needs into account and by incorporating patient's wishes for the level of aggressiveness of treatment, offers a model of integrating medical care with social support services. It holds the promise of controlling health care costs while improving quality of care by providing a better match of services to patient needs. Three decades after the CGA was initially developed in England, oncologists have begun taking notice on the potential benefits that CGA might bring to the field of geriatric oncology. This article describes the utilization of the CGA in cancer patients with an eye toward promoting interdisciplinary care for older cancer patients. To set an initial context, a search of computerized databases took place, using "comprehensive geriatric assessment" and "cancer" as keywords. A selection of literature from between 1980 and 2003 was reviewed. Additional articles were identified through the bibliography of relevant articles.