Integration of geriatric oncology in daily multidisciplinary cancer care: the time is now.

This study aims to investigate the effects of illustrations in online cancer information on older cancer patients' website satisfaction (i.e. satisfaction with the attractiveness, comprehensibility and emotional support from the website) and recall of information. In an online experiment, 174 younger (<65 years) and older (≥65 years) colorectal cancer patients were randomly exposed to a webpage about transanal endoscopic microsurgery consisting of either text-only information, text with two cognitive illustrations or text with two affective illustrations. In general, adding cognitive illustrations compared with text-only information improved the satisfaction with the attractiveness of the website in both younger and older patients. For older patients in particular, cognitive illustrations facilitated recall of cancer information: whereas older patients recalled less information overall compared with younger patients (39% vs. 50%), no statistically significant differences in age on recall were observed when cognitive illustrations were added to text. Furthermore, older patients were more satisfied with the emotional support from the website than younger patients, especially when affective illustrations were present. Our results suggest that effective online cancer communication for ageing populations involves considering both cognitive and affective illustrations to enhance website satisfaction and recall of cancer information.

G8 screening and health-care use in patients with cancer

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review

PURPOSE: Comprehensive geriatric assessment (CGA) has aided the medical community greatly in understanding the quality-of-life issues and functional needs of older patients. With its professional team assessment approach, however, CGA may be time consuming and costly. The goal of the present study was to assess the ability of cancer patients to complete a self-administered CGA and then to characterize cancer patients across multiple domains and age groups. PATIENTS AND METHODS: Two hundred sixty-six male outpatient oncology patients at the Durham Veterans Affairs Medical Center were asked to fill out a survey assessing 10 domains (demographics, comorbid conditions, activities of daily living, functional status, pain, financial well being, social support, emotional state, spiritual well-being, and quality of life). RESULTS: Seventy-six percent of the patients who received their surveys and kept their appointments returned the assessment tool. Older oncology patients had significantly less education (P < .0001), income (P = .05), frequent exercise (P = .01), and chance of being disease free (P = .003) than younger patients. Other findings in older patients were a higher rate of marriage (P = .02), more difficulty in taking medications (P = .05), and less cigarette (P = .03) and alcohol (P = .03) use. Members of all age cohorts reported a sense of social support, with younger patients deriving this more from family and friends than older patients, and older patients deriving social support more from membership in religious communities than younger patients. No differences were found across age groups for number and impact of comorbid illnesses, number of medications, basic and instrumental activities of daily living, pain, overall health rating, financial adequacy, anxiety, depression, and quality of life. CONCLUSION: CGA can be conducted in an outpatient cancer community using a self-report format. Despite the fact that this population varied demographically across age groups and is limited to veterans, this study demonstrated remarkable similarities between younger and older cancer patients in terms of functional status, health states, and quality of life.

Comprehensive geriatric assessment (CGA) has aided the medical community greatly in understanding the quality-of-life issues and functional needs of older patients. With its professional team assessment approach, however, CGA may be time consuming and costly. The goal of the present study was to assess the ability of cancer patients to complete a self-administered CGA and then to characterize cancer patients across multiple domains and age groups. Two hundred sixty-six male outpatient oncology patients at the Durham Veterans Affairs Medical Center were asked to fill out a survey assessing 10 domains (demographics, comorbid conditions, activities of daily living, functional status, pain, financial well being, social support, emotional state, spiritual well-being, and quality of life). Seventy-six percent of the patients who received their surveys and kept their appointments returned the assessment tool. Older oncology patients had significantly less education (P <.0001), income (P =.05), frequent exercise (P =.01), and chance of being disease free (P =.003) than younger patients. Other findings in older patients were a higher rate of marriage (P =.02), more difficulty in taking medications (P =.05), and less cigarette (P =.03) and alcohol (P =.03) use. Members of all age cohorts reported a sense of social support, with younger patients deriving this more from family and friends than older patients, and older patients deriving social support more from membership in religious communities than younger patients. No differences were found across age groups for number and impact of comorbid illnesses, number of medications, basic and instrumental activities of daily living, pain, overall health rating, financial adequacy, anxiety, depression, and quality of life. CGA can be conducted in an outpatient cancer community using a self-report format. Despite the fact that this population varied demographically across age groups and is limited to veterans, this study demonstrated remarkable similarities between younger and older cancer patients in terms of functional status, health states, and quality of life.

Comment on ‘Older cancer patients in an Italian hospice’

The best treatment for older patients with breast cancer

Breast cancer is the most prevalent cancer among women worldwide, with 45% of them over 65 years old. Older breast cancer patients tend to be underrepresented and understudied in major clinical trials. This narrative review provides a comprehensive overview of the current evidence regarding treatment decision-making, treatment toxicities, and proposed survivorship management recommendations for geriatric cancer patients. A literature search was conducted on PubMed and Google Scholar. The search strategy included a combination of keywords related to clinical management and treatment toxicities of older cancer breast cancer patients. English articles published between May 1990 to May 2024 were included. Older breast cancer patients represent a heterogeneous group with specific needs and treatment considerations. Treatment decisions for geriatric cancer patients should be based on a comprehensive geriatric assessment (CGA), which considers the patient's functional status, comorbidities, and preferences, rather than relying solely on chronological age. Breast cancer surgery is generally well tolerated in older patients, with a low rate of systemic complications and 30-day post-surgery mortality. In selected elderly patients, axillary surgery may be omitted to minimize side effects. The choice of endocrine therapy should take into account the side effect profile, patient's comorbidities, concomitant medications, and preferences. While aromatase inhibitors provide better efficacy, musculoskeletal side effects and osteoporosis may be a concern for older patients. CDK4/6 inhibitors have a similar efficacy in elderly patients as younger patients, but the incidence of neutropenia and dose modifications or interruptions are more frequent. Reported radiotherapy side effects are similar across age groups, although the occurrence of radiation-induced pulmonary toxicities was found to be associated with old age. Chemotherapy is reserved for triple-negative and HER2-positive disease in elderly patients due to known side effects. such as neutropenia, cardiotoxicity, and cognitive impairment. Data on the efficacy and safety of immunotherapy use in older patients are limited. Physicians should make additional efforts to evaluate age-specific treatment efficacy and treatment-induced toxicities. Further efforts to enhance the representation of older patients in breast cancer trials are warranted.

ALL in Older Adults

Background: Elderly patients have been receiving a sub-standard treatment for early breast cancer when compared to younger age group patients. A higher percentage of them are being treated with primary endocrine therapy (PET) based on the premise that they may not survive surgery or live long enough to benefit from it. In clinical practice, however, there is no validated assessment in place to assess their surgical risk or estimate their life expectancy. This study aimed to optimize the treatment of early breast cancer in older patients using comprehensive geriatric assessment (CGA). It tested the hypothesis that CGA could be used to predict 2-year survival in older breast cancer patients. Based on that a treatment algorithm was devised which could be used to recommend whether PET or surgery plus endocrine treatment would be best indicated in individual patients. Methods: The study included women &amp;gt;70 years of age with early breast cancer, seen in a dedicated Leicester clinic between 04/2005 and 04/2007. All patients had comprehensive assessment including documentation of co-morbidities, Mini-mental state examination (MMSe), Geriatric depression score (GDS), Activities of daily living (ADL), Instrumental activities of daily living (IADL) and American society of anesthesiologist score (ASA). Analysis was performed to find components of the CGA that were helpful in predicting 2-year survival in these patients. Results: 123 patients were included; age range was 70–94 (median-82). Twenty-two patients died within 2-years. Logistic regression analysis found MMSe, ADL, and ASA score to have an independent association with 2-year survival. A statistically significant correlation (p-value 0.000) was found between the dichotomized combined-score of these components and 2-year survival. Breast Cancer in Elderly Treatment Algorithm (BCETA) was devised using the scores of these three components. Patients who scored one or higher (high-risk group), were found to have &amp;lt;48% two-year survival; those, who scored zero (low-risk group), have &amp;gt;86% chance of two-year survival. The overall accuracy for the algorithm was 81%. Conclusion: Breast Cancer in Elderly Treatment Algorithm is a new and systematic approach to optimize the management of breast cancer in elderly patients. It is helpful in identifying high-risk patients with expected short-survival who may benefit from PET, if their cancer is hormone receptor positive. Patients with predicted longer life expectancy (low-risk) may be recommended standard treatment. A prospective study is ongoing at Leicester research clinic to validate the results. BREAST CANCER IN ELDERLY TREATMENT ALGORITHM Name: Hospital No: DOB: Address: Diagnosis: COMPREHENSIVE GERIATRIC ASSESSMENT TOTAL BCETA SCORE Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-23-03.

N05 - The G8 screening as a tool for malnutrition risk

Comprehensive Geriatric Assessment and Its Clinical Impact in Oncology

Purpose: This study aims to investigate the impact of comprehensive Geriatric Assessment (CGA) on treatment decisions in a large cohort of older breast cancer patients. We also studied the functional evolution during treatment and the development of severe toxicity in patients receiving chemotherapy and we looked for predictive baseline markers of functional decline and toxicity. Patients and methods: This study is part of a study on CGA in older cancer patients in 6 tumor types. We selected the breast cancer cohort for this presentation: 379 older breast cancer patients were recruited in 2 Belgian university hospitals. Patients aged 70 years or older with a newly diagnosed or progressive breast cancer for which treatment initiation or change was considered, were eligible. At baseline, an evaluation was performed of the oncological parameters as well as a CGA including geriatric screening with G8 and Flemish version of the TRST, pain, social situation, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), presence of falls, MNA, GDS-15, MOB-T for fatigue, MMSE, polypharmacy, and Charlson Comorbidity Index (CCI). CGA results were communicated to the treating physician and after treatment decision, the physician was interviewed by a trained healthcare worker using a predefined questionnaire focusing on unknown geriatric problems revealed by CGA, subsequent planning of geriatric interventions, and impact on treatment decision. At 2–3 months follow-up, functionality was reassessed and severe toxicity in patients receiving chemotherapy (n = 98) was recorded. Predictors for functional decline (ADL increase of ≥2 points and IADL decrease of ≥1 point compared to baseline) and severe haematological and non-haematological toxicity were identified by multivariate analysis. Results: 79,2% of treating physicians were aware of CGA results at the time of treatment decision. CGA revealed unknown geriatric problems in 70,5% of cases, leading to geriatric intervention in 5,4% of patients. Treatment was adapted according to age and standard clinical approach (without CGA taken into account) in 41,1% of cases and CGA results led to an additional change of treatment decision in 5,4%. At follow-up, 47,9% of patients was dependent on at least one of the activities of ADL (compared to 54,1% at baseline) and 64,7% was dependent on at least one of IADL (compared to 58,1% at baseline). Functional decline at 2–3 months was predicted by baseline ADL, IADL and ECOG-PS, but no markers were found to predict chemotherapy toxicity (which occurred in 22/98 pts: 14 hematological toxicity gr III-IV, and 10 non-hematological toxicity gr III-IV) Conclusion: CGA revealed unknown information in the majority (70.5%) of breast cancer patients but led to a geriatric intervention and a change in treatment decision in a minority of pts (both 5.4%). Baseline functionality measures (ADL, IADL, ECOG-PS) were found to be predictive for functional decline at 2–3 months, but predictors for severe chemotherapy toxicity could not be identified. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-09-07.

Study Sets Treatment Standard for Elderly With Colon Cancer

The incidence of cancer increases with advanced age and the majority of cancer deaths are in patients aged ≥ 65. The geriatric population is a heterogeneous group and a patient's chronologic age does not always correlate with underlying physiologic status. Oncologists need to be able to obtain information on physiologic and functional capacity in older patients in order to provide safe and effective treatment recommendations. The Comprehensive Geriatric Assessment (CGA) is a compilation of validated tools that predict morbidity and mortality in community-dwelling older adults. The various components of the CGA have also been shown to influence clinical decision-making and predict outcomes in older cancer patients. The combined data from the CGA can be used to stratify patients into risk categories to better predict their tolerance to treatment and risk for chemotherapy toxicity. However, the CGA is a comprehensive tool requiring significant time and training to perform. A variety of screening tools have been developed which may be useful in the general oncology practice setting to identify patients that may benefit from further testing and intervention. This chapter will review the components and predictive value of CGA in older cancer patients, with emphasis on how CGA can practically be incorporated into clinical practice.