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Audisio RA. Preoperative evaluation of the older patient with cancer. J Geriatr Oncol 2016; 7:409-412. [PMID: 27133287 DOI: 10.1016/j.jgo.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/28/2015] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
The lack of knowledge has helped us in progressing with the aim of offering the right surgical treatment to the right patient at the right time. Preoperative assessment of frailty identifies those patients who are at a higher operative risk, more prone to develop complications, spend more time in hospital and cost more to the community. Phase IV trials are becoming essential in expanding our understanding, while randomized clinical trials are unlikely to add substantial value in this field of clinical research.
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Affiliation(s)
- Riccardo A Audisio
- University of Liverpool, St Helens Teaching Hospital, Marshalls Cross Road, St Helens WA9 3DA, UK.
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Approach to Evaluating the Multimorbid Patient with Cardiovascular Disease Undergoing Noncardiac Surgery. Clin Geriatr Med 2016; 32:347-58. [PMID: 27113151 DOI: 10.1016/j.cger.2016.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Older patients undergo more inpatient and outpatient procedures than do younger individuals, and their risk of suffering undesired outcomes is greater. The performance of a productive preoperative assessment entails more than the application of the sundry clinical practice guidelines relating to a patient's various medical diagnoses. A better approach involves adoption of a physiologically integrated, whole-person assessment that takes into account the patient's cognitive function, mood, physical function and mobility (including the possibility of frailty), social support, nutritional status, and medication use. This article outlines such an approach and highlights the many gaps in the current evidence base.
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Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, Köhne CH, Rostoft S, Lemmens V, Mitry E, Rutten H, Sargent D, Sastre J, Seymour M, Starling N, Van Cutsem E, Aapro M. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 2014; 26:463-76. [PMID: 25015334 DOI: 10.1093/annonc/mdu253] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Europe and worldwide, with the peak incidence in patients >70 years of age. However, as the treatment algorithms for the treatment of patients with CRC become ever more complex, it is clear that a significant percentage of older CRC patients (>70 years) are being less than optimally treated. This document provides a summary of an International Society of Geriatric Oncology (SIOG) task force meeting convened in Paris in 2013 to update the existing expert recommendations for the treatment of older (geriatric) CRC patients published in 2009 and includes overviews of the recent data on epidemiology, geriatric assessment as it relates to surgery and oncology, and the ability of older CRC patients to tolerate surgery, adjuvant chemotherapy, treatment of their metastatic disease including palliative chemotherapy with and without the use of the biologics, and finally the use of adjuvant and palliative radiotherapy in the treatment of older rectal cancer patients. An overview of each area was presented by one of the task force experts and comments invited from other task force members.
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Affiliation(s)
- D Papamichael
- Department of Medical Oncology, B.O. Cyprus Oncology Centre, Nicosia, Cyprus
| | | | - B Glimelius
- Department of Radiology, Oncology and Radiation Science, University of Uppsala, Uppsala, Sweden
| | | | | | - D Haller
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, USA
| | - C-H Köhne
- Klinikum Oldenburg, Oldenburg, Germany
| | - S Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - V Lemmens
- Erasmus MC University Medical Centre, Rotterdam Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), Eindhoven, The Netherlands
| | - E Mitry
- Department of Medical Oncology, Institut Curie, Paris Université Versailles Saint-Quentin, Guyancourt, France
| | - H Rutten
- Catharina Hospital Eindhoven, Eindhoven Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - J Sastre
- Department of Medical Oncology, Hospital Clinico San Carlos, Madrid, Spain
| | - M Seymour
- Cancer Medicine and Pathology, University of Leeds, Leeds
| | - N Starling
- Gastrointestinal Unit, Royal Marsden Hospital, London, UK
| | - E Van Cutsem
- Digestive Oncology, Leuven Cancer Institute, Leuven, Belgium
| | - M Aapro
- SIOG Office, Clinique de Genolier, Genolier, Switzerland
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Abstract
Elderly patients constitute the largest group in oncologic medical practice, despite the fact that in solid cancers treated operatively, many patients are denied standard therapies and where such decision making is based solely on age. The “natural” assumptions that we have are often misleading; namely, that the elderly cannot tolerate complex or difficult procedures, chemotherapy, or radiation schedules; that their overall predictable medical health determines survival (and not the malignancy); or that older patients typically have less aggressive tumors. Clearly, patient selection and a comprehensive geriatric assessment is key where well-selected cases have the same cancer-specific survival as younger cohorts in a range of tumors as outlined including upper and lower gastrointestinal malignancy, head and neck cancer, and breast cancer. The assessment of patient fitness for surgery and adjuvant therapies is therefore critical to outcomes, where studies have clearly shown that fit older patients experience the same benefits and toxicities of chemotherapy as do younger patients and that when normalized for preexisting medical conditions,that older patients tolerate major operative procedures designed with curative oncological intent. At present, our problem is the lack of true evidence-based medicine specifically designed with age in mind, which effectively limits surgical decision making in disease-based strategies. This can only be achieved by the utilization of more standardized, comprehensive geriatric assessments to identify vulnerable older patients, aggressive pre-habilitation with amelioration of vulnerability causation, improvement of patient-centered longitudinal outcomes, and an improved surgical and medical understanding of relatively subtle decreases in organ functioning, social support mechanisms and impairments of health-related quality of life as a feature specifically of advanced age.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Aviv, Israel 52621.
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