Integrating a Geriatric Evaluation in the Clinical Setting
Section snippets
Introduction: The Two-Step Approach
It is now well established that older cancer patients present a significant prevalence of geriatric problems. Approximately 20% have an Eastern Cooperative Oncology Group performance status (PS) of ≥2. An equal proportion of patients have a dependence in basic activities of daily living (ADL). More than half have a dependence in instrumental activities of daily living (IADL). More than 90% have at least 1 comorbidity, and 30%-40% of those comorbidities are severe. Depression is present in
Short Screening Tools
These are rapid triage tools taking only a few minutes to answer. This is an area in active development, and the list that follows does not claim to be exhaustive. However, some instruments that were used and tested in recent articles are described in the following sections.
Step 2: Integrated Geriatric Oncology Management
Once a patient screens positive for geriatric problems a combined oncogeriatric approach should be set up. This can take several formats. The International Society of Geriatric Oncology (SIOG) recently presented its list of the 10 Global Priorities to address the care of older cancer patients.29 Among them is to “Develop interdisciplinary geriatric oncology clinics, especially in academic institutions and comprehensive cancer centers.” We believe that major centers should have geriatric
Risk Prediction Models
The prediction of treatment outcome in a situation where multidimensional variables occur, as with the older patient, is difficult. Trained oncologists have difficulty integrating in their treatment plan >3 variables at one time.31 Our interpretation of the patient's desires might be biased by cultural expectations,32, 33 and our reading of the literature is selective due to time constraints. Therefore, good quality decision models based on systematic reviews of available data are very valuable.
Recommendations, Perspectives, Research Needed
In summary, there is an increasing amount of evidence that geriatric parameters should be considered when planning cancer treatment. We recommend identifying or setting up a local oncogeriatric team in an appropriate format. Even if the volume of consultations might initially be low, the effect is likely to be multiplied by a mutual educational process. We recommend choosing 1 short screening tool assessing several geriatric domains in conjunction with the local geriatric support to optimize
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