Clinical Experience
Onco-Geriatric Approach for the Management of Older Patients with Cancer

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Introduction and Rationale

The number of older cancer patients is increasing with global aging of the population. A close interaction between oncologists and geriatricians becomes necessary to (1) better evaluate the elders’ health status, (2) determine their residual clinical/biological reserves, and (3) optimize the provided medical care. In fact, aggressive antineoplastic managements are often denied to older patients, possibly because of the common misconception suggesting older age and/or clinical complexity as absolute contraindications to advanced treatments.

Methods

The primary aim of the presented project is to assess whether assigning a geriatrician to provide daily medical care to older cancer patients (aged 65 years and older) admitted to an oncology ward increases the number of patients eligible for a chemotherapeutic and/or surgical intervention. The project is articulated in 2 phases: (1) a retrospective phase based on analysis of data collected over the 2 years before the beginning of the study, and (2) a prospective 2-year intervention. Additional information about clinical conditions, biological parameters, adverse drug reactions, body composition, physical function, and 1-year health-related events will also be recorded.

Outcomes

The combination of expertise from oncologists and geriatricians is likely to result in (1) an improved selection of candidates for interventions aimed at increasing disability-free life expectancy and/or overall survival, and (2) a more rational exclusion of patients at higher risk of toxicity or with poor prognosis. In this article, the development of an onco-geriatric unit aimed at the evaluation, management, and treatment of older women with gynecological cancer is also described.

Section snippets

Methods

Since 2007, through a Swiss Bridge Foundation (Zurich, Switzerland) award, we have been conducting a 3-year study (Figure 1) aimed at the evaluation of the impact of an onco-geriatric unit on several patients’ outcomes. The primary aim of the project is to assess whether assigning a geriatrician to provide daily medical care to older cancer patients (aged 65 years and older) admitted to an oncology ward may increase the number of patients eligible for a chemotherapeutic and/or surgical

Outcomes

Structured cooperation within a multidisciplinary team between oncologists and geriatricians needs to be carefully considered to provide adequate medical care for a graying cancer population.72 Such clinical activity can be defined as a coordinated effort of medical oncologists, surgeons, geriatricians, physiotherapists, nurses, and social workers. The activation of such geriatric oncology programs or onco-geriatric units could be a relatively easy organizational measure to take. This approach

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    The authors have declared they have no conflicts of interest.

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