Challenges Facing Radiation Oncologists in The Management of Older Cancer Patients: Consensus of The International Geriatric Radiotherapy Group.

Tiberiu Popescu,Ulf Karlsson,Te Vuong,Brigitta Baumert,Lurdes Trigo,Micaela Motta,Alice Zamagni,Arthur Myint,Nam Nguyen,Vincent Vinh-Hung,Juliette Thariat,Pedro Lara,Marta Bonet,Meritxell Arenas

doi:10.3390/cancers11030371

Abstract

The management of older cancer patients remains difficult because of data paucity. Radiation oncologists need to identify potential issues which could affect treatment of those patients. A workshop was organized in Barcelona among international radiation oncologists with special interest in the management of older cancer patients on April 22, 2018. The following consensus was reached: 1. Older cancer patients often faced unconscious discriminating bias from cancer specialists and institutions because of their chronological age. 2. Advances in radiotherapy techniques have allowed patients with multiple co-morbidities precluding surgery or systemic therapy to achieve potential cure in early disease stages. 3. The lack of biomarkers for frailty remains an impediment to future research. 4. Access to healthcare insurance and daily transportation remains an issue in many countries; 5. Hypofractionation, brachytherapy, or stereotactic techniques may be ideally suited for older cancer patients to minimize transportation issues and to improve tolerance to radiotherapy. 6. Patients with locally advanced disease who are mentally and physically fit should receive combined therapy for potential cure. 7. The role of systemic therapy alone or combined with radiotherapy for frail patients needs to be defined in future clinical trials because of targeted agents or immunotherapy may be less toxic compared to conventional chemotherapy.

Highlights

Management of older cancer patients remains a challenge as normal organ function declines over the years [1] and the number of co-morbidity factors increases with age [2]
A panel of 14 international radiation oncologists discussed those issues through email and was able to identify six topics that needed to be addressed during the workshop: 1)
Cancer in older patients is often diagnosed at a locally advanced or metastatic stage because current government policy frequently imposes an upper age limit for cancer screening [22,23]. This discrimination occurred despite the fact that over 60% of all cancers occurred in people older than 65, and by 2030, 20% of the U.S population will be in that age group [24]

Summary

Introduction

Management of older cancer patients remains a challenge as normal organ function declines over the years [1] and the number of co-morbidity factors increases with age [2]. Invasive procedures such as curative surgery may be precluded in frail individuals with early stages disease [3]. Some patients may have underlying frailty which may affect treatment outcome if undetected, highlighting the difficulty of their management because of the absence of clear guidelines While historically it may be true, radiation oncology has evolved significantly over the past 20 years due to advances in imaging and radiotherapy techniques. This allows precise targeting of the tumor to a high dose and potential cure despite the presence of multiple co-morbidity factors [6]

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Discussion

Conclusion