Abstract
Age is the most important risk factor for the occurrence of cancer, and a declining mortality from heart disease and other non-cancer causes leaves an older population that is at high risk of developing cancer. Choosing the optimal treatment for older cancer patients may be a challenge. Firstly, older age and associated factors such as comorbidities, functional limitations, and cognitive impairment are risk factors for adverse effects of cancer treatment. Secondly, older patients are often excluded from clinical trials, and current clinical guidelines rarely address how to manage cancer in patients who have comorbidities or functional limitations. The importance of incorporating frailty assessment into the preoperative evaluation of older surgical patients has received increasing attention over the last 10 years. Furthermore, studies that include endpoints such as functional status, cognitive status, and quality of life beyond the standard endpoints, i.e. postoperative morbidity and mortality, are starting to emerge. This review looks at recent evidence regarding geriatric assessment and frailty in older surgical cancer patients and provides a summary of newer studies in colorectal, liver, pancreatic, and gynecological cancer and renal and central nervous system tumors.
Highlights
The majority of cancer patients are older, and, since surgery is one of the key treatment modalities in cancer, medical professionals need to keep up to date with recent advances in cancer surgery for older patients
We look at publications from the last five years on geriatric assessment (GA) and frailty in older surgical cancer patients
We focused on papers regarding GA and frailty in cancer surgery as well as selected specific cancer types: colorectal, liver, pancreatic, and gynecological cancer as well as renal and central nervous system (CNS) tumors
Summary
The majority of cancer patients are older, and, since surgery is one of the key treatment modalities in cancer, medical professionals need to keep up to date with recent advances in cancer surgery for older patients. Over the last 10 years, the importance of incorporating frailty assessment in the preoperative work-up for older surgical cancer patients has become evident since it has been shown that it successfully predicts the length of hospital stay, complications, survival, and costs[1,2]. There is a strong need for selecting older patients for the right treatment. Older patients are heterogeneous, ranging from fit patients with a long life expectancy to frail patients with a very short life expectancy, and chronological age alone is a poor predictor of life expectancy and treatment outcomes[3,4,5]. Lack of information to risk-stratify older patients for treatment may lead to undertreating fit older patients and over-treating frail older patients. We look at publications from the last five years on geriatric assessment (GA) and frailty in older surgical cancer patients. We will present selected studies in colorectal, liver, pancreatic, and gynecological cancers as well as renal and central nervous system (CNS) tumors, with a particular focus on publications that include GA and frailty data
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