Managing the elderly person with cancer: A geriatrician's perspective

Abstract

In Hong Kong, 53% of new patients with cancer were aged over 65 years, the incidence of cancer being 8-fold higher than that in younger subjects, and 75% of cancer deaths occur in people aged over 60 years. When cancer is suspected or diagnosed in an elderly person, the doctor faces multiple challenges: diagnostic uncertainty because of multiple pathologies, multiple aetiologies, and cancer mimics; and treatment uncertainty from lack of any evidence-base on risk-benefit. In addition, there are ethical issues in relation to 'under-treatment' or 'over-treatment', and the need for sensitive and compassionate communication with the elderly patient and his | her family. Cancer treatment decisions should be based on biological age, which takes into account of the elderly individual's functioning and reserve, rather than the chronological age. Biological age is best estimated by comprehensive geriatric assessment, a multidimensional diagnostic process focused on determining the individual's medical, psychological, and functional capabilities. Clinical trials of comprehensive geriatric assessment in oncology have demonstrated benefits in recognising unsuspected geriatric problems and syndromes, predicting treatment outcomes and survival, and in implementing multidisciplinary intervention plans. The goals of treatment of cancer in an elderly person include: cure if possible, prolongation of survival, prolongation of active life expectancy, symptom management, sympathetic care and support, and preservation of quality of life. The management of the elderly person with cancer benefits from an individualised approach based on comprehensive geriatric assessment and the input of a geriatrician. In the past decade, collaboration between oncologists and geriatricians has emerged as a clinical model, whereby geriatric principles and oncological assessment were integrated for the care of elderly persons with cancer. © 2013 Hong Kong College of Radiologists.