In this E-Learning module, the authors elaborate demographics of cancer and aging, issues related to chronological versus functional age, the aging process and its impact on organs and systems, comprehensive geriatric assessment, prediction scores related to chemotherapy toxicity in older patients and the participation of older patients with cancer in clinical research.
This is an update of a previous ESMO E-Learning module that captures advances in this field occurred in the last several years and now performed within the umbrella of the ESMO/SIOG Cancer in the Elderly Working Group activities dedicated to better education of oncologists on cancer issues in older patients with cancer.
Elderly is a subjective cultural concept that varies from culture to culture, depending on a mixture of health-related, social and economic factors. In industrialised societies, 70 years old is a standard cut-off point used to define a person as older; however, in other, poorer or more traditional societies, a lower age may be more appropriate.
People with the same chronological age can have widely different functional ages. In geriatric oncology, it is the functional age that determines management and the authors emphasise that a great deal of effort is dedicated to accurately evaluate functionality and its maintaining during the treatment.
Aging leads to decline in organ functions and this decline can be less than obvious based on tests alone. The authors elaborate a concept of frailty related to the aging process, screening tools, principles of comprehensive geriatric assessment and a range of problems relevant in geriatric oncology practice like a functional status, comorbidities, estimating life expectancy, cognition, psychological state, nutrition, fatigue, social support, use of medications, and geriatric syndromes.
The authors also provide examples of scales/tools with regard to different domains, they compare the tools, elaborate prediction tools in terms of chemotherapy associated toxicities and provide a completely new chapter on the participation of older patients with cancer in clinical trials.
The authors conclude that older patients will dominate future oncology practice. More initiatives are necessary to educate oncologists and integrate geriatrics into usual oncology practice and services. Critically, more elderly-centred studies with appropriate endpoints are necessary to provide the basis for more specific treatment standards that will allow to close the gap that currently exists between younger and older patients, and will lead to better outcomes in this patients population.
