Early Palliative Care for the Geriatric Patient with Cancer

Older adults with cancer present with complex multidimensional problems. Therefore, early integration of palliative care for the older adult with cancer is important, and a multidisciplinary team approach is critical for optimum care. The importance of incorporating geriatric and palliative concerns in assessment, as well as early involvement of the multidisciplinary team, is discussed as a manner of addressing the needs of older adults with cancer. Concerns related to metabolic changes that can occur with aging, as well as risk for polypharmacy and inappropriate prescribing for older adults, are also reviewed.

Aging microenvironment and antitumor immunity for geriatric oncology: the landscape and future implications

The tumor microenvironment (TME) has been extensively investigated; however, it is complex and remains unclear, especially in elderly patients. Senescence is a cellular response to a variety of stress signals, which is characterized by stable arrest of the cell cycle and major changes in cell morphology and physiology. To the best of our knowledge, senescence leads to consistent arrest of tumor cells and remodeling of the tumor-immune microenvironment (TIME) by activating a set of pleiotropic cytokines, chemokines, growth factors, and proteinases, which constitute the senescence-associated secretory phenotype (SASP). On the one hand, the SASP promotes antitumor immunity, which enhances treatment efficacy; on the other hand, the SASP increases immunosuppressive cell infiltration, including myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs), M2 macrophages, and N2 neutrophils, contributing to TIME suppression. Therefore, a deeper understanding of the regulation of the SASP and components contributing to robust antitumor immunity in elderly individuals with different cancer types and the available therapies is necessary to control tumor cell senescence and provide greater clinical benefits to patients. In this review, we summarize the key biological functions mediated by cytokines and intercellular interactions and significant components of the TME landscape, which influence the immunotherapy response in geriatric oncology. Furthermore, we summarize recent advances in clinical practices targeting TME components and discuss potential senescent TME targets.

Evaluation of a comprehensive geriatric assessment tool in geriatric cancer patients undergoing adjuvant chemotherapy: a pilot study

PURPOSE

It is recommended to use comprehensive geriatric assessment (CGA) in clinical oncology practice to improve care for geriatric cancer patients and to identify medical and social issues that may need further intervention. The purpose of this pragmatic pilot study was to evaluate the effectiveness of the Hurria et al. CGA in cancer patients 70 years of age or older undergoing adjuvant chemotherapy, as well as the feasibility of integrating it into a busy clinic practice and the psychosocial impact on these patients.

METHOD

Twenty-five patients were recruited. Descriptive analysis was performed via a geriatric assessment questionnaire completed by the participants prior to their first adjuvant chemotherapy treatment and during follow-up, 2 to 6 weeks after last treatment. Additionally, study staff performed a geriatric healthcare assessment at both time points.

RESULTS

The results of this pilot study show that administration is feasible despite some challenges. Administration of a CGA in a clinic setting presented some logistical issues with regard to time and space available in clinic. Analysis of patient data indicated only minor variations in patient domains from pre-chemo to post-chemo confirming previous research. Participants expressed gratitude for the extra time spent with them at a stressful time in their lives.

CONCLUSION

Further information regarding the usefulness of a comprehensive geriatric assessment with regard to improving treatment selection, identifying undetected medical problems, and avoiding toxicity will be obtained if the administration of comprehensive geriatric questionnaires is incorporated into the clinic setting and considered into the allocated time for staff workload.