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 New Study Pushes for Improvements to Cancer Care for Elders

The gap between what oncologists know about geriatric care and how to treat elderly patients with cancer should be bridged at least in part by having all patients age 65 and older receive a geriatric assessment when considering whether to undergo chemotherapy, according to a new study by the American Society of Clinical Oncology.

The study said fewer than 25 percent of older cancer patients currently get assessments to examine functional abilities, psychological status, nutrition, cognition, social circumstances, and coexisting medical conditions, which can play major factors in the potential toxicity of chemotherapy.

The study, “Community Oncologists’ Decision-making for Treatment of Older Patients with Cancer,” noted that as the baby boomer generation ages, so do the number of older patients with cancer. In order to treat this rising number of cancer cases for the older-aged patient, the study authors said more evidence-based data are needed to better deal with the unique problems these patients face compared with younger people with cancer.

This is because older patients with cancer have a higher rate of comorbidities, geriatric syndromes, and disabilities than younger patients and older patients without cancer. In addition, these patients carry a high risk of developing significant chemotherapy toxicity, functional and cognitive loss, and physical decline while on treatment, the study said.

“The under-representation of older adults in clinical trials places them at risk of receiving inappropriate under- or over-treatment for their cancer, leading to disparities in outcomes,” the report said. “For example, fit older patients are less likely to receive an evidence-based standard of care cancer treatment than younger patients, while older patients with both cancer and comorbid conditions are too often treated with therapies with high toxicity rates and low likelihoods of benefit.

This issue recently caused the Institute of Medicine (IOM) to acknowledge that the current systems in place for cancer care are ill-prepared to care for the most vulnerable patients with cancer, notably those 80 years and older.

“Despite the rapidly increasing numbers of older patients with cancer, most oncologists have received little geriatrics training, so common aging-related conditions that influence outcomes are rarely detected,” the IOM report said.

For the Society of Clinical Oncology study, researchers brought together community oncologists for two multisite geriatric oncology trials. The participants shared their beliefs about and confidence in caring for older adults. They were also asked to make a chemotherapy recommendation for a hypothetical case of an older patient with advanced pancreatic cancer.

“Each oncologist received one randomly chosen vignette [case] that varied on three variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant,” the study said.

The results showed that the majority of oncologists agreed that “the care of older adults with cancer needs to be improved” (89 percent) and that “geriatrics training is essential” (72 percent). But, less than 25 percent were “very confident” in recognizing dementia or conducting a fall risk or functional assessment, and only 23 percent reported using the geriatric assessment.

For the randomly varied patient characteristic on whether to treat the hypothetical patient with chemotherapy, when all cases were accounted for (age, impaired function, cognitive impairment) a total of 52 percent of oncologists said they would offer chemotherapy.

The study’s conclusion is that geriatric-relevant information, when available, strongly influences community oncologists’ treatment decisions.

See more information on the study at https://tinyurl.com/y8fkfofz.

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