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Geriatric oncology research to improve clinical care

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.

Key Points

  • The available evidence suggests that functional limitations, comorbidity, cognitive decline, and/or limited social support correlate with toxicity to therapy and cancer outcomes in patients aged 65 and over

  • Information from the comprehensive geriatric assessment can be used to stratify patients into risk categories to better predict their tolerance to treatment and follow functional consequences from treatment

  • Although fit, older adults do as well as their younger counterparts when receiving treatment within clinical trials, older adults are at increased risk for treatment-related toxic effects

  • The proportion of older adults in trials should include those with underlying health status characteristics that better reflect the age and health status of patients seen in the community

  • The focus for treatment within oncology clinical research to be 'more aggressive' continues to accentuate the current under-representation of older adults

  • When caring for older cancer patients in oncology offices, the necessary additional time should be provided to perform assessments and to monitor and manage toxicities

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Figure 1: Cancer is associated with functional deficits, vulnerability, and frailty.

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Authors and Affiliations

Authors

Contributions

S. Mohile and A. Hurria researched the data for the article. All authors contributed to discussions of the content, wrote and edited the manuscript before submission.

Corresponding author

Correspondence to Supriya Mohile.

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Competing interests

A. Hurria has received research support from the following companies: Celgene and GlaxoSmithKline. A. Hurria has also acted as a consultant for the following companies: Genentech, GTx and Seattle Genetics. The other authors declare no competing interests.

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Mohile, S., Dale, W. & Hurria, A. Geriatric oncology research to improve clinical care. Nat Rev Clin Oncol 9, 571–578 (2012). https://doi.org/10.1038/nrclinonc.2012.125

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