Abstract
Cancer is a disease of aging, and oncologists are faced with the challenge of providing evidence-based treatment to a growing number of older adults with cancer. Cancer and aging share common biologic and cellular mechanisms, and older adults have age-related changes in all organ systems that decrease the tolerance to both cancer and its treatments. Presently, generic scales and chronologic age are used to determine a treatment course, assess eligibility for clinical trials, and predict treatment toxicity and survival. However, these parameters offer a poor reflection of the functional status of older patients and should not be the main factor guiding decision making. In contrast, the geriatric assessment is a multidimensional diagnostic evaluation aimed at providing a comprehensive overview of an older patient's functional status, cognition, comorbidities, psychological status, social functioning, and nutritional status. Although this comprehensive evaluation is able to identify important areas of vulnerability for which targeted interventions can be applied, it is not commonly taught in oncology training or used in oncology practice. In this chapter, we discuss the fundamental science behind the geriatric assessment, and review the clinical applications of a geriatric assessment-based approach to the prevention and treatment of cancer in older adults.
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