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Fine-Tuning Cancer Care for Older Adults

Clinical oncologists call for more comprehensive assessment before starting chemotherapy

A doctor with an elderly patient

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Before cancer treatment, a geriatric assessment is advised for patients 65 and older.

In a move to improve cancer care for older adults, the American Society of Clinical Oncology (ASCO) is recommending that all patients age 65 and older receive a geriatric assessment when considering or undergoing chemotherapy.

The goal is to better identify who can tolerate intensive chemotherapy and who may need modified treatment regimens because of underlying conditions, such as cognitive impairment, that often go undetected by oncologists.

Fewer than 25 percent of older cancer patients currently get these assessments, which evaluate physical ability, psychological status, nutrition, cognition, social circumstances and other, coexisting medical conditions, and which can predict the potential toxicity of chemotherapy.

The new guideline, ASCO’s first in the field of “geriatric oncology,” may have significant potential to change medical practice.

The move recognizes a shifting demographic reality for cancer specialists, who are treating increasingly older patients as life spans lengthen. In the U.S., 60 percent of patients newly diagnosed with cancer (an estimated 1.7 million people this year) are age 65 or older, as are more than 60 percent of cancer survivors.

Yet evidence about how best to treat older adults with cancer is weak because older adults are underrepresented in clinical trials. And most oncologists have received little training in how to manage older patients’ unique vulnerabilities.

When researchers asked 305 community oncologists about evaluating older patients, 89 percent acknowledged “the care of older adults with cancer needs to be improved,” according to a recently published study. Fewer than 25 percent said they were “very confident” they could identify dementia or accurately assess a patient’s functioning or risk of falling — factors associated with poorer outcomes for cancer treatment.

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