Breast lump in an 85-year-old woman with dementia: a decision analysis

Comorbidity: implications for research and practice in geriatric oncology

The aging of the population and the emergence of cancer as a major disease of older age require the development of new strategies of cancer management in older adults, in particular, strategies based on the special characteristics of older patients, such as the effects of concurrent health conditions, i.e. comorbidity. This paper is a consideration of the implications of current research on comorbidity for research and practice in geriatric oncology. Subjects include considerations of representative measures of comorbidity; sources of data; screening and early diagnosis; prognosis, treatment, and outcome; and physiological mechanisms. Recommendations for future research include the development of (a) more refined measures of comorbidity; (b) new studies of comorbidity and cancer treatment; (c) investigations of the contributions of comorbidity for geriatric assessment and a new generation of clinical trials, (d) examinations of physiological mechanisms linking comorbidity with health outcomes; and (e) the development of an epidemiology of comorbidity.

Assessment of the older cancer patient

The correct assessment of a cancer patient is a key step in the treatment process. In older people, this assessment entails not only the patient's basic medical history and the standard cancer staging, but also much more comprehensive evaluation of the various facets of the patient's health and environment that may interfere with his or her therapy. Patient fitness for elective surgery, radiation therapy, and chemotherapy must be considered. Geriatricians have defined the relevant aspects of the general evaluation of the older person, and now this work is being adapted to cancer patients. This article reviews the various aspects of a comprehensive assessment applicable to the cancer patient in settings such as academic oncology programs, cooperative group studies, and private oncology practice.

Cancer in the frail patient. A coming epidemic

With the aging of the population, frailty has emerged as a new clinical entity. The frail person has exhausted any functional reserve. Current criteria for the recognition of frailty include age of over 85 years, dependence in one or more activities of daily living, three or more comorbid conditions, and the presence of one or more geriatric syndromes. It is calculated that there are approximately 6 million frail patients in the United States and approximately 400,000 of them have cancer. Management of cancer in the frail person is mainly comprised of palliation, which may include some forms of chemotherapy, such as navelbine, gemcitabine, or low-dose taxanes.