Should your patient have that oncology intervention?
Interventions (medical and surgical) may have unintended consequences/effects.
Pharmacologic interventions should be adjusted based on renal function, body composition, and side effect profile.
Medical problems are frequently multifactorial (physical, cognitive, functional, and social), thus diagnosis/management is best approached through a multifaceted plan of care.
1. Gather in-depth information regarding physical, cognitive, and social issues.
4. Generate approximate prognosis of life expectancy.
In patients with a single primary disease process, prognosis can be estimated with a disease-specific instrument.
In non-curative disease, treatment is aimed at palliating symptoms and extending disease-related life expectancy.
All chemotherapy and targeted therapy regimens have potential side effects which must be taken into consideration in determining whether therapy meets the patient's care goals.
Score predicts low (0-5), intermediate (6-9), or high (10-19) risk of Grade 3-5 chemotherapy toxicities.
Elderly patient with oncologic disease considering treatment intervention.
Determine appropriateness of oncologic intervention in the geriatric oncology patient through assessment of their overall physical health, cognition, function and social situation.
The NCI SEER Database reports that from 2006-2010, approximately 53% of cancers were diagnosed in patients > 65 years of age, with the median age at diagnosis of 66 years.
The pathophysiology of cancer is complex. Cancer is deregulated cell growth and invasion resulting from genetic alterations that may be inherited or acquired with age. A multistep process of mutations (5-10 estimated mutations) is required for progression from a single mutated cell to metastasis. The most common cancers in the elderly include those arising from the lung, prostate, breast, and colon. Symptoms from malignancy can be related to the primary tumor, metastatic lesions, or paraneoplastic syndromes. Therapy for cancer can range from traditional cytotoxic chemotherapy to supportive care alone. Response rates and survival estimates vary depending upon disease, stage, performance status, and treatment regimen.
• List geriatric assessment tools to help identify patients who may benefit from oncologic intervention.
• Identify factors that may increase morbidity and mortality in older adults with oncologic disease.
• Formulate an appropriate prognosis of life expectancy.
Howlader N, Noone AM, Krapcho M, et al (eds.) SEER cancer statistics review, 1975- 2010, National Cancer Institute. Bethesda, MD. Based on November 2012 SEER data submission, posted to the SEER web site 2013.
Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother. 2007; 5(3):263-303.
Walter LC, Lewis CL, Barton MB. Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence. Am J Med. 2005; 118(10):1078-86.
Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011; 29:3457-3465.
Users are free to download and distribute Geriatric Fast Facts for Informational, educational, and research purposes only. Citation: Gabriel Manzi MD, Nicholas Dreger, Kathryn Denson MD, Patrick Foy MD, Thomas Giever MD, Fast Facts and Concepts #36 Should your patient have that oncology intervention?