cancer patients who are very healthy can usually tolerate cancer treatments.
Most elderly patients have comorbidities, however, and oncologists are being
urged to conduct a comprehensive geriatric evaluation before deciding on a
course of treatment.
The recommendation comes from Martine Extermann, MD, of the
Senior Adult Oncology Program (SAOP), H. Lee Moffitt Cancer Center &
Research Institute, University of South Florida, Tampa. She told the 14th
international meeting of the Multinational Association for Supportive Care in
Cancer (MASCC) and International Association for Oral Oncology that many
problems affecting prognosis are not currently detected before cancer
"We have good data that some form of geriatric
assessment improves care," she told ONI in an interview. "And
now we have several screening tools available
. . . they are not perfect, but they can help the busy physician screen for the
most important problems with as little as a 5-minute assessment."
Dr. Extermann recommended that physicians use results from a
rapid geriatric screening and comprehensive geriatric assessment to place
elderly patients in one of three categories (see Figure):
1. Healthy. Patient is in good condition except for cancer
and can tolerate high-dose chemotherapy or radiation therapy.
2. Vulnerable. Patient looks healthy but is at increased
risk of complications and of dying within the next few years. Treat with
tailored, lower-dose treatment regimens that minimize toxicity.
3. Frail. Patient cannot survive aggressive treatment and
should be given tailored treatment or palliative care.
"The challenge in oncology is to define and target the
vulnerable population," she said. Patients in her program have three
comorbidities on average, and 5% take as many as 10 medications each day.
"Before you can treat a problem, you need to detect it," she said,
warning that malnutrition, depression, and cognitive disorders are often missed
if the patient is not screened.
As many as one third of all elderly cancer patients are
depressed, but most are not diagnosed because they are more likely to
rationalize than to cry about their problems, Dr. Extermann said. "We are
not diagnosing depression well, and I think it’s dangerous to act on an
inadequate diagnosis," she said. She noted that she has been surprised to
find that some patients who seemed fine screened positive for depression while
others who appeared depressed screened well and were able to handle