Geriatric oncology research to improve clinical care.

James Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
Nature Reviews Clinical Oncology (Impact Factor: 15.03). 07/2012; 9(10):571-8. DOI: 10.1038/nrclinonc.2012.125
Source: PubMed

ABSTRACT Cancer incidence increases with advanced age. The Cancer and Aging Research Group, in partnership with the National Institute on Aging and NCI, have summarized the gaps in knowledge in geriatric oncology and made recommendations to close these gaps. One recommendation was that the comprehensive geriatric assessment (CGA) should be incorporated within geriatric oncology research. Information from the CGA can be used to stratify patients into risk categories to better predict their tolerance of cancer treatment, and to follow functional consequences from treatment. Other recommendations were to design trials for older adults with study end points that address the needs of the older and/or vulnerable adult with cancer and to build a better infrastructure to accommodate the needs of older adults to improve their representation in trials. We use a case-based approach to highlight gaps in knowledge regarding the care of older adults with cancer, discuss our current state of knowledge of best practice patterns, and identify opportunities for research in geriatric oncology. More evidence regarding the treatment of older patients with cancer is urgently needed.

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    ABSTRACT: Multiple myeloma is a disease of older adults, with two-thirds of patients aged ≥ 65 years and having varying comorbidities, functional status, and cognitive status. Patients ≥ 65 are usually considered ineligible for transplant. The introduction of novel agents, including immunomodulatory drugs such as lenalidomide and proteasome inhibitors such as bortezomib and carfilzomib, has improved treatment tolerance and resulted in improved outcomes for older patients. We present an individualized approach for older patients, “staging” patient age using Comprehensive Geriatric Assessment (CGA) to stratify into fit, unfit and frail groups to guide treatment decisions, including whether or not to transplant, use two-drug versus three-drug combinations, or use reduced-intensity regimens.
    Current Geriatrics Reports. 09/2014; 3(3).
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    ABSTRACT: Despite the lack of definitive data on the impact of Comprehensive Geriatric Assessment (CGA) in the geriatric oncology setting, the broad use of any form of CGA is strongly recommended before any treatment decision in elderly cancer patients (ECP); currently there is no consensus about the best format for this geriatric assessment. The aim of this study was to firstly test the Multidimensional Prognostic Index (MPI) in ECP with locally advanced or metastatic disease. Patients aged ≥70years with inoperable or metastatic solid cancer consecutively admitted to our Program of Geriatric Oncology were assessed by a multidisciplinary team and received a basal CGA to calculate the MPI score. A hundred and sixty patients entered the study. In the Cox's regression model, MPI, CIRS-SI, BSA, GDS, MMSE, chemotherapy and a diagnosis of primary lung cancer were associated with mortality at 6 and 12months. The ROC curves confirmed the prognostic value of MPI, with the best discriminatory power for mortality at both 6 and 12months. The present study is the first to indicate that the MPI retains its prognostic value even in elderly cancer patients with advanced stage of disease. The CIRS-SI and the GDS may potentiate the prognostic value of MPI.
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May 26, 2014