Addressing the challenges of cancer care in older adults: The unique benefits of oncogeriatric evaluation and management

Dear Editor,

Age is the single major risk factor for most cancers, including hematological malignancies, with population aging posing a growing concern worldwide. In Europe, the median age at diagnosis for hematological malignancies is 69 years; incidence increases with age, reaching a maximum at 75–99 years.¹ Survival for patients aged 75 years and older with hematological malignancies is generally poor, particularly for those with acute leukemias. The incidence of solid tumors also increases with age, with the presence of frailty, malnutrition and comorbidities associating a higher risk for mortality in elderly patients diagnosed with cancer.² Understanding outcome variability, treatment challenges, and the impact of frailty and comorbidities among older patients is of utmost importance if we are to manage the burden of cancer in the aging population correctly.³

Along with the aging population, the increasing cost of oncological treatments is another major challenge that healthcare systems face today. Strategies developed to minimize the impact of these challenges include promoting the use of generic and biosimilar medications, negotiating drug prices, evaluating the cost–benefit profile of different treatments, promoting the prevention and early diagnosis of cancer, and optimizing access to therapy. The judicious use of digital health tools merits special attention, as studies demonstrate improved cancer care outcomes and reduced costs⁴; digital health interventions for older patients with cancer have shown to improve clinical outcomes⁵ and increase access to care, especially in patients with reduced mobility. A careful design, taking care to bridge the “digital divide”, is vital to the success of digital health interventions for geriatric patients.

In the context of population aging and budget constraints, geriatric oncology could be the key to addressing the unique challenges presented by cancer treatment in older patients, and fundamental to patients’ quality of life and survival.⁶ Geriatric oncology focuses on cancer treatment in older people and uses comprehensive geriatric assessment to develop personalized treatment plans tailored to patients’ individual needs. The Community of Madrid's Plan for the Attention of Frailty and Healthy Aging⁷ prioritizes the early detection of frailty in those clinical processes in which frailty could reduce treatment tolerance or put patients at risk for functional decline. Unfortunately, the widespread implementation of geriatric oncology programs is yet to be achieved, despite multiple arguments which justify the benefits of such an approach.⁸

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  Geriatric oncology programs permit personalized care by developing individualized treatment plans depending on each patient's needs, thus avoiding unnecessary treatments and ensuring that patients receive an appropriate and effective treatment according to their health status and therapeutic tolerance.

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  Geriatric oncology programs (GOPs) reduce direct spending on oncology treatments, as well as costs associated with ineffective therapy and avoidable side effects.

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  GOPs improve patients’ quality of life through comprehensive care and geriatric evaluation, which reduce the morbidity and mortality associated with cancer in older patients.

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  GOPs increase access to care by implementing technological advances such as telemedicine to provide support for patients with limited mobility.

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  GOPs address the aging population. With the increase in life expectancy, the incidence of cancer in older people is expected to rise, highlighting the need to ensure that older patients receive appropriate and personalized treatment.

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  GOPs contribute to healthcare system sustainability by reducing cancer treatment-associated costs in older patients.

Multiple publications underline the need for implementing geriatric programs for older patients with cancer, demonstrating the efficacy of comprehensive geriatric evaluation for these patients though outcomes such as improved quality of life, reduced healthcare spending, and reduced prescription of unnecessary oncology treatments.⁹

Some countries, such as France and the UK,¹⁰ have modified cancer care policies in patients over 70 to include comprehensive geriatric evaluation and personalized care, with results including improved quality of life and reduced direct healthcare spending.

In summary, there are overwhelming arguments to convince healthcare services of the need for geriatric oncology programs. Healthcare managers cannot ignore this need if the sustainable improvement of cancer care in older adults is truly a priority. Geriatric oncology offers a personalized model of care tailored to the needs of each patient, reducing spending on oncology treatment, improving patients’ quality of life, providing solutions to address population aging, and contributing to the sustainability of the healthcare system.