Considerations for Supporting the Older Adult with Cancer with Daniel Lander, ND, FABNO & Sukriti Bhardwaj, ND
Cancer has a disproportionate impact on older people. In fact, 60% of people diagnosed with cancer are 65 years of age or older, as are 60% of cancer survivors. Despite the high burden of cancer in the older population, cancer treatment guidelines have continued to focus on younger and relatively healthier patients and there are unique considerations to account for when supporting older people with cancer. It has become clear that it is crucial to complete a comprehensive geriatric assessment (CGA) in this population and use the results to inform subsequent treatment decisions and planning. In addition to assessing physical functioning, a CGA also evaluates social and caregiver support, cognitive performance, mobility and balance, mental-emotional health, nutritional status, existing comorbidities, and polypharmacy. These assessments have been shown to accurately predict the extent of treatment-related toxicities and can positively impact survival. When used to guide treatment decisions, a CGA has been found to improve quality of life, reduce high-grade treatment-related toxicity and significantly decrease treatment discontinuation, hospital utilization, and unplanned hospital admissions compared to usual care. In the case of limited time and resources, more simplified geriatric screening tools, e.g. the Vulnerable Elders Survey (VES-13) can be used to identify patients who may be especially vulnerable or frail and may benefit from a full CGA. Several geriatric screening tools have been validated for their ability to assess functional decline and predict poorer survival in the oncology population including the Geriatric 8 (G8), the VES-13, the Triage Risk Screening Tool and the Geriatric Depression Scale-15. The Cancer Aging and Research Group (CARG) chemotherapy toxicity calculator and the Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) score assist healthcare providers with assessing a patient’s risk for treatment-related toxicities and as such, help inform the process of patient-centred decision-making when considering treatment options in older patients. In addition to informing treatment decisions these tools can also help healthcare providers identify patients who are at higher risk and may require closer monitoring and follow-up and those who may benefit from referrals to other healthcare professionals for additional supportive care. In managing older adults with cancer, an understanding of their functional health status is as essential as an understanding of their cancer type and stage. The use of geriatric assessment and screening tools can help pinpoint areas where further support is required, predict treatment-related toxicities and survival in addition to assisting with clinical decision-making. Naturopathic doctors play a unique and important role in both advocating for our older patients to undergo appropriate geriatric assessments to optimize outcomes but also providing important integrative supportive care.
Learning Objectives
To understand the differences in managing older adults with cancer compared to their younger counterparts
To describe common geriatric concerns among older people with cancer including frailty, fatigue, cognitive impairment and their implications for shared decision-making and treatment planning
To become familiar with the comprehensive geriatric assessment and various geriatric screening tools available for use in the oncology setting and understand implications of the results on outcomes, prognosis, treatment planning and shared decision-making
To develop strategies for incorporating the use of geriatric screening tools in a busy naturopathic clinical practice and understand how to use results for providing supportive care
Cancer has a disproportionate impact on older people. In fact, 60% of people diagnosed with cancer are 65 years of age or older, as are 60% of cancer survivors. Despite the high burden of cancer in the older population, cancer treatment guidelines have continued to focus on younger and relatively healthier patients and there are unique considerations to account for when supporting older people with cancer. It has become clear that it is crucial to complete a comprehensive geriatric assessment (CGA) in this population and use the results to inform subsequent treatment decisions and planning. In addition to assessing physical functioning, a CGA also evaluates social and caregiver support, cognitive performance, mobility and balance, mental-emotional health, nutritional status, existing comorbidities, and polypharmacy. These assessments have been shown to accurately predict the extent of treatment-related toxicities and can positively impact survival. When used to guide treatment decisions, a CGA has been found to improve quality of life, reduce high-grade treatment-related toxicity and significantly decrease treatment discontinuation, hospital utilization, and unplanned hospital admissions compared to usual care. In the case of limited time and resources, more simplified geriatric screening tools, e.g. the Vulnerable Elders Survey (VES-13) can be used to identify patients who may be especially vulnerable or frail and may benefit from a full CGA. Several geriatric screening tools have been validated for their ability to assess functional decline and predict poorer survival in the oncology population including the Geriatric 8 (G8), the VES-13, the Triage Risk Screening Tool and the Geriatric Depression Scale-15. The Cancer Aging and Research Group (CARG) chemotherapy toxicity calculator and the Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) score assist healthcare providers with assessing a patient’s risk for treatment-related toxicities and as such, help inform the process of patient-centred decision-making when considering treatment options in older patients. In addition to informing treatment decisions these tools can also help healthcare providers identify patients who are at higher risk and may require closer monitoring and follow-up and those who may benefit from referrals to other healthcare professionals for additional supportive care. In managing older adults with cancer, an understanding of their functional health status is as essential as an understanding of their cancer type and stage. The use of geriatric assessment and screening tools can help pinpoint areas where further support is required, predict treatment-related toxicities and survival in addition to assisting with clinical decision-making. Naturopathic doctors play a unique and important role in both advocating for our older patients to undergo appropriate geriatric assessments to optimize outcomes but also providing important integrative supportive care.
Learning Objectives
To understand the differences in managing older adults with cancer compared to their younger counterparts
To describe common geriatric concerns among older people with cancer including frailty, fatigue, cognitive impairment and their implications for shared decision-making and treatment planning
To become familiar with the comprehensive geriatric assessment and various geriatric screening tools available for use in the oncology setting and understand implications of the results on outcomes, prognosis, treatment planning and shared decision-making
To develop strategies for incorporating the use of geriatric screening tools in a busy naturopathic clinical practice and understand how to use results for providing supportive care
Cancer has a disproportionate impact on older people. In fact, 60% of people diagnosed with cancer are 65 years of age or older, as are 60% of cancer survivors. Despite the high burden of cancer in the older population, cancer treatment guidelines have continued to focus on younger and relatively healthier patients and there are unique considerations to account for when supporting older people with cancer. It has become clear that it is crucial to complete a comprehensive geriatric assessment (CGA) in this population and use the results to inform subsequent treatment decisions and planning. In addition to assessing physical functioning, a CGA also evaluates social and caregiver support, cognitive performance, mobility and balance, mental-emotional health, nutritional status, existing comorbidities, and polypharmacy. These assessments have been shown to accurately predict the extent of treatment-related toxicities and can positively impact survival. When used to guide treatment decisions, a CGA has been found to improve quality of life, reduce high-grade treatment-related toxicity and significantly decrease treatment discontinuation, hospital utilization, and unplanned hospital admissions compared to usual care. In the case of limited time and resources, more simplified geriatric screening tools, e.g. the Vulnerable Elders Survey (VES-13) can be used to identify patients who may be especially vulnerable or frail and may benefit from a full CGA. Several geriatric screening tools have been validated for their ability to assess functional decline and predict poorer survival in the oncology population including the Geriatric 8 (G8), the VES-13, the Triage Risk Screening Tool and the Geriatric Depression Scale-15. The Cancer Aging and Research Group (CARG) chemotherapy toxicity calculator and the Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) score assist healthcare providers with assessing a patient’s risk for treatment-related toxicities and as such, help inform the process of patient-centred decision-making when considering treatment options in older patients. In addition to informing treatment decisions these tools can also help healthcare providers identify patients who are at higher risk and may require closer monitoring and follow-up and those who may benefit from referrals to other healthcare professionals for additional supportive care. In managing older adults with cancer, an understanding of their functional health status is as essential as an understanding of their cancer type and stage. The use of geriatric assessment and screening tools can help pinpoint areas where further support is required, predict treatment-related toxicities and survival in addition to assisting with clinical decision-making. Naturopathic doctors play a unique and important role in both advocating for our older patients to undergo appropriate geriatric assessments to optimize outcomes but also providing important integrative supportive care.
Learning Objectives
To understand the differences in managing older adults with cancer compared to their younger counterparts
To describe common geriatric concerns among older people with cancer including frailty, fatigue, cognitive impairment and their implications for shared decision-making and treatment planning
To become familiar with the comprehensive geriatric assessment and various geriatric screening tools available for use in the oncology setting and understand implications of the results on outcomes, prognosis, treatment planning and shared decision-making
To develop strategies for incorporating the use of geriatric screening tools in a busy naturopathic clinical practice and understand how to use results for providing supportive care