Abstract
The number of oncology, surgery and anaesthesia procedures in older patients has greatly increased in recent years due to ageing populations. Older patients are typically characterised by physical changes such as comorbidities, decline in physiological activities and cognitive impairment. All these factors, together with polypharmacological therapies, may substantially impact perioperative outcome, quality of recovery and, more in general, quality of life. A comprehensive multidisciplinary approach to perioperative care is thus needed. The assessment of frailty has a central role in the pre-operative evaluation of older patients and, with a multidisciplinary approach. The best surgical procedures and oncologic therapies can be accurately discussed in the pre- and post-operative periods. All clinicians involved in this scenario should be proactive in multidisciplinary care to achieve better outcomes.
Highlights
Introduction and backgroundIt is well known that cancer is typically an age-related disease with approximately 60% of all newly diagnosed malignant tumours and 70% of all cancer deaths occurring in persons aged 65 years or older [1]
It is supposed that almost 50% of patients >70 years will experience severe chemotherapy-related toxicity [2], and 60% will have post-operative complications after colorectal cancer surgery, 78% of which will be severe ones [3]
Besides the evaluations already described, the other evaluations of older patients are recommended as a fundamental part of the global evaluation of the patient: the evaluation of instrumental activity of daily living (IADL) [55] is recommended, and several studies demonstrated how an impairment in any of the areas considered are associated with the risk of chemotherapy toxicity, mortality, hospitalisations and functional decline [56]
Summary
It is well known that cancer is typically an age-related disease with approximately 60% of all newly diagnosed malignant tumours and 70% of all cancer deaths occurring in persons aged 65 years or older [1]. Besides the evaluations already described, the other evaluations of older patients are recommended as a fundamental part of the global evaluation of the patient: the evaluation of IADL [55] is recommended, and several studies demonstrated how an impairment in any of the areas considered are associated with the risk of chemotherapy toxicity, mortality, hospitalisations and functional decline [56]. Assessing the cognition in older patient should be a key part in geriatric evaluation: the use of validated tools such MMSE or Mini-Cog is recommended by international guidelines, and a low score in these evaluations has been associated with poorer survival and increased chemotherapy toxicity risk [39]
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