Abstract

RODRIGUEZ COUSO, Myriam. Geriatric interventions in the older with cancer based on comprehensive geriatric assessment. Optimization areas: what the geriatrician can contribute to the multidisciplinar team. Nutr. Hosp. [online]. 2020, vol.37, n.spe1, pp.38-47.  Epub July 06, 2020. ISSN 1699-5198.  https://dx.doi.org/10.20960/nh.02988.

The ageing of the world population, the early detection of some types of tumours, and the increasing survival rates demand/claim a change of model in the specific care of older cancer patient. According to recent data, it is estimated that there will be 29.5 million patients with cancer in 2040, more than 50% of them over 65 years. Most cancer-related deaths and survivorships also belong to this group of age.

In this context, the multidisciplinary management of these processes and the development of oncogeriatric oncology become more relevant, both in the decision-making process and in the planning of interventions that affect oncological treatment outcomes and patients' survival, autonomy and quality of life.

The evaluation by a geriatrician identifies vulnerability areas using the comprehensive geriatric assessment (CGA) as the key tool, leading us to detect problems that are unidentified by the Eastern Cooperative Oncology Group Performance Status (ECOG) or the Karnofsky index (IK) and bringing us valuable information, essential in the decision-making process. It is useful as a prognostic tool and predicts oncological treatment toxicity. It includes the assessment of frailty (the elderly's health is measured in terms of "function", which helps us to stratify cancer elderly patients for specific oncological treatments and non-oncological interventions, because it could be reversible, preventable or at least minimized). National and international societies (National Comprehensive Cancer Network [NCCN], American Society of Clinical Oncology [ASCO], International Society of Geriatric Oncology [SIOG] and Spanish Society of Medical Oncology [SEOM]) recommend a CGA for all patients over 70 years potentially treatable with an oncological treatment. Different screening methods have been developed to identify who benefits more.

In the basis of geriatric assessment, we have to design interventions on uncovered impairments or vulnerabilities. One of the most relevant is nutritional intervention, because malnutrition is frequent in cancer elderly patients, with devastating consequences. The prescription of exercise forms an inseparable duo with the nutritional intervention. Another intervention is the exhaustive revision of medication and the creation of a "de-prescription" plan. A cognitive screening before the start of oncological treatment is essential in order to know the patient's basal cognitive state, as well as to evaluate the presence of dementia as the main competing mortality factor and the patient's understanding and capacity to take decisions before planning the treatment. Other geriatric interventions include optimization of comorbid chronic conditions, mood and sleep disorders, and social issues.

To conclude, the evaluation by a geriatrician allows to identify impairments, classify the elderly, uncover vulnerability and intervene on it, and predict treatment-related toxicity and mortality, taking part on the decision making process. The CGA offers the possibility to apply a tailored treatment according to the characteristics of each patient. Investigation is necessary in order to get specific evidence to adapt care models working in a multidisciplinary way. Therefore, the collaboration between the different specialists that are involved in the care of cancer elderly patient is essential.

Keywords : Aged; Neoplasms; Geriatric oncology; Geriatric intervention; Comprehensive geriatric assessment.

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