At the 2024 annual meeting of the Society of Urologic Oncology (SUO), Dr. Sindhuja Kadambi delivered a compelling presentation on the complexities of treating genitourinary cancers in older adults. Highlighting the unique challenges faced by this growing patient population, Dr. Kadambi emphasized the need for a personalized approach that considers both longevity and quality of life.
Dr. Kadambi opened her presentation with a hypothetical case: a 72-year-old man diagnosed with stage II muscle-invasive urothelial carcinoma. This patient, with a history of heart disease, emphysema, sleep apnea, and other chronic conditions, presented a classic example of the complex medical landscape often encountered in geriatric oncology.
“Is he a candidate for neoadjuvant chemotherapy and radical cystectomy?” Dr. Kadambi posed the question, underscoring the critical need for individualized treatment plans.
Dr. Kadambi pointed out that bladder cancer patients tend to be older than those with other genitourinary cancers, with most patients exceeding 65 years of age. Though, she stressed that “age is just a number” and that chronological age alone cannot dictate treatment decisions.
To illustrate this point, Dr. Kadambi presented three scenarios for a 72-year-old man, each with vastly different life expectancies based on overall health and functional status:
- Excellent health, no medical issues, independent: life expectancy is 17-21 years
- Poor health, COPD, cognitive impairment, needs assistance with daily activities: life expectancy is 4-5 years
- Good health, congestive heart failure, difficulty with physical activities: life expectancy is 9-10 years
Dr. Kadambi emphasized the high prevalence of chronic conditions in older adults, citing data showing the ten most common co-occurring chronic conditions among Medicare beneficiaries.
Her research has shown that geriatric syndromes,such as frailty and cognitive impairment,can significantly impact cancer outcomes,leading to increased symptom burden,treatment complications,and reduced quality of life.
“Physicians also tend to underestimate vulnerability and impairment of their patients,” Dr. Kadambi noted, citing a study that found a important discrepancy between physician and patient assessments of functional status.
Dr. Kadambi concluded by emphasizing the importance of a comprehensive geriatric assessment in guiding treatment decisions for older adults with cancer. This assessment, which considers physical, cognitive, and psychosocial factors, can help predict treatment toxicity, guide care management, and ultimately improve patient outcomes.
“geriatric oncology is essentially balancing the importance of survival with the importance of quality of life,” Dr. Kadambi stated.
She highlighted the benefits of a comprehensive geriatric assessment, which can help predict toxicity and mortality, guide treatment decisions, foster interaction between patients and their care teams, and ultimately improve clinical outcomes.
A recent presentation at the 2020 American Society of Clinical Oncology (ASCO) conference highlighted the crucial role of geriatric assessment in improving cancer care for older adults. Dr. Sindhuja Kadambi of the University of Rochester emphasized the significant benefits of incorporating geriatric assessment into standard care for this vulnerable population.
Research presented by Mohile et al. demonstrated that prospective randomized trials incorporating geriatric assessment, compared to usual care, yielded remarkable results. These included:
- Detection of previously unidentified geriatric syndromes
- Reduction in severe (grade 3-5) chemotherapy side effects
- Decreased emergency department visits
- Fewer unplanned hospitalizations
- Lower rates of treatment discontinuation
- Improved quality of life
- Increased referrals for supportive care
Dr. Kadambi explained that geriatric assessment serves multiple purposes in caring for older cancer patients: risk prediction, tailoring cancer treatment, implementing interventions, and facilitating communication.
She highlighted the ACS NSQIP Surgical Risk Calculator as a valuable tool for quickly assessing surgical risk in geriatric patients. this calculator not only predicts outcomes like mortality and length of stay but also anticipates geriatric-specific complications such as postoperative delirium. For predicting chemotherapy toxicity,Dr. Kadambi recommended the tool developed by the Cancer and Aging Research Group (CARG), which she noted is more accurate than the conventional Karnofsky performance status.
Dr.Kadambi acknowledged that the model of geriatric care varies depending on the healthcare setting.Academic cancer centers may have dedicated geriatric oncology units, while larger hospitals might have geriatric consultation teams. In community or smaller hospitals,geriatric expertise may be limited.
Summarizing her presentation, Dr. Kadambi emphasized the following key takeaways regarding genitourinary cancer care in older adults:
- All older patients with genitourinary cancer should undergo a geriatric assessment.
- Geriatric assessment can aid in treatment decision-making and improve patient outcomes.
- Geriatric assessment can be implemented across various healthcare settings, regardless of resource availability.
- Early integration of geriatric specialists into cancer care is highly recommended.
- There is a pressing need for “geriatricized” clinical trials.
Presented by: Sindhuja Kadambi, MD, MS, University of Rochester, Rochester, NY
References:
- Kadambi S, Loh KP, Dunne R, et al. Older adults with cancer and their caregivers – current landscape and future directions for clinical care. Nat Rev Clin oncol. 2020 Dec;17(12):742-755.
- Bergerot CD, Philip EJ, Bergerot PG, et al. Discrepancies between genitourinary cancer patients’ and clinicians’ characterization of the Easter Cooperative Oncology Group performance status. Cancer 2020 Oct 2 [Epub ahead of print].
- Shahrokni A, Tin AL, Sarraf S, et al. Association of Geriatric Comanagement and 90 Day Postoperative mortality among patients aged 75 years and older with cancer.JAMA Netw Open.2020 Aug 3;3(8):e209265.
A groundbreaking study presented at the 2020 American Society of Clinical oncology (ASCO) annual meeting has highlighted the growing importance of geriatric assessments in cancer care. The research,conducted by Dr.Eduardo z-de-Celis, Dr. Matti Aapro,and Dr. Harvey Muss, emphasizes the need to tailor treatment plans to the unique needs of older adults with cancer.
“The geriatric assessment is a multidimensional evaluation that goes beyond simply considering a patient’s chronological age,” explained Dr. z-de-Celis. “It takes into account factors like functional status, cognitive ability, social support, and co-existing medical conditions, all of which can significantly impact treatment tolerance and outcomes.”
The study’s findings underscore the fact that older adults are a diverse population with varying levels of health and resilience. A one-size-fits-all approach to cancer treatment can be detrimental, potentially leading to unnecessary side effects and compromised quality of life.
“By incorporating geriatric assessments into routine clinical practise, oncologists can gain a more comprehensive understanding of their older patients’ individual needs and tailor treatment plans accordingly,” stated Dr. Aapro.”This personalized approach can help maximize treatment benefits while minimizing potential harm.”
the researchers believe that widespread adoption of geriatric assessments has the potential to revolutionize cancer care for older adults, leading to improved outcomes and enhanced quality of life.
dr. Muss added,”This is a crucial step towards ensuring that all cancer patients,regardless of age,receive the most appropriate and effective care possible.”
the full study, titled “The Geriatric assessment Comes of Ages,” was published in the November 2020 issue of The Oncologist.
For more data on geriatric oncology and the importance of personalized cancer care, visit the American Society of Clinical Oncology website at https://www.asco.org/.
This article discusses the importance of geriatric assessment in treating older adults with genitourinary cancer. Here are the key takeaways:
**Geriatric Syndromes and Cancer Outcomes:**
* Older adults are more susceptible too geriatric syndromes like frailty and cognitive impairment, which can negatively impact cancer treatment outcomes. These syndromes can lead to:
* Increased side effects from treatment
* More complications during treatment
* Reduced quality of life
**The Role of Geriatric assessment:**
* Dr. Kadambi emphasizes the importance of comprehensive geriatric assessments (CGAs) for older cancer patients. CGAs go beyond standard medical evaluations and consider:
* Physical health (strength, mobility, etc.)
* Cognitive function (memory, attention, etc.)
* Psychosocial factors (social support, emotional well-being, etc.)
* **Benefits of CGA:**
* Accurately predict treatment toxicity and mortality risk.
* Guide treatment decisions to ensure the most appropriate and tolerable options.
* Improve communication between patients, families, and healthcare providers.
* Enhance overall clinical outcomes.
**evidence Supporting Geriatric Assessment:**
* Research presented by Mohile et al.showed that incorporating CGA into cancer care led to significant improvements:
* Detection of previously undetected geriatric syndromes
* Reduced severe chemotherapy side effects
* Fewer emergency visits and hospitalizations
* Increased quality of life
* more referrals for supportive care
**Tools for Geriatric Assessment:**
* **ACS NSQIP Surgical Risk Calculator:** Predicts surgical outcomes and geriatric-specific complications (e.g., postoperative delirium).
* **CARG Chemotherapy Toxicity Tool:** More accurate than the customary Karnofsky Performance Status in predicting chemotherapy side effects.
**Integration of Geriatric Expertise:**
* The model for geriatric care varies depending on the healthcare setting: Dedicated units in academic centers, consultation teams in large hospitals, and limited access in smaller settings.
* Early involvement of geriatric specialists is crucial.
**Key Recommendations:**
* All older adults with genitourinary cancer should undergo CGA.
* CGA should inform treatment decisions and improve patient outcomes.
* Geriatric assessment can be implemented in various healthcare settings.
* “Geriatricized” clinical trials are needed to better understand cancer treatment in older adults.
**Overall Message:**
Geriatric assessment is essential for providing tailored and effective cancer care to older adults. It promotes better understanding of individual needs and risks, leading to improved treatment outcomes and quality of life.
