The application of the principles of geriatrics to the management of the older person with cancer
Section snippets
What does aging mean?
The casual observer, with no clinical background, won't have any problems in distinguishing young and old in Fig. 1 a and b, that portrays a pair of twins at the time of their first and their ninetieth birthday. At the extremes of life, clear hallmarks establish the transition between infancy and young adulthood and between old adulthood and frailty, the last step of life prior to death (Fig. 2). The intermediate transition, that holds critical clinical implications, the transition between
The comprehensive geriatric assessment (CGA)
Broad agreement exists on the areas that should be tested in a CGA (Table 2), though the format of CGA is not standardized [13]. The following discussion illustrates consensus and controversies pertaining to the CGA. The risk of comorbid conditions increases with age: Fried et al. calculated that the average number of diseases for community dwelling elderly aged 77 was 3.7 [14]. As expected, the prevalence of competitive causes of death increases correspondingly: Ragland and Satariano showed
Application of the CGA to the practice of oncology
The CGA may help the management of older individuals with cancer in at least three areas: detection of frailty, treatment of unsuspected conditions, removal of social barrier to treatment.
The frail person, by definition, is the person who has exhausted any meaningful functional reserve (Table 4). As such the frail person has a negligible capacity to cope with stress and is not a candidate for aggressive life-prolonging treatment. This does not mean however, that the frail person has a
Summary
Aging involves changes in different domains, including health, function, cognition, emotional and social status. These changes, that are highly individualized, influence the treatment of cancer in several ways: limited life-expectancy, decreased tolerance to treatment, inability to obtain treatment due to a number of social barriers. CGA accounts for the diversity of the geriatric population. The CGA allows recognition of frailty, management of unsuspected conditions and removal of some
Reviewers
The reviewers for this article are: Prof. Silvio Monfardini, Division of Medical Oncology, Azienda Ospedaliera di Padova, I-35128 Padova, Italy; Dr Lazzaro Repetto, Istituto per la Ricerca sul Cancro, Oncologia Medica I, Largo Rosanna Benzi 32, I-16132 Genova, Italy; and Dr William B. Ershler, Eastern Virginia Medical School, 825 Fairfax Avenue, Room 201, Norfolk, VA 23507-1914, USA.
Lodovico Balducci, Professor of Medicine and Attending Physician, University of South Florida College of Medicine, Program Leader, Senior Adult Oncology Program, Tampa FL. Editor of two textbooks of geriatric oncology and about 150 publications in the field of cancer and aging.
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Lodovico Balducci, Professor of Medicine and Attending Physician, University of South Florida College of Medicine, Program Leader, Senior Adult Oncology Program, Tampa FL. Editor of two textbooks of geriatric oncology and about 150 publications in the field of cancer and aging.