Framing the Preoperative Assessment of the Oncogeriatric Patient. The Surgeon’s Point of View

  • 4 Accesses


Elderly cancer patients constitute a steadily rising population and present a challenge for their physicians, who are confronted not only with medical questions, but also with ethical and social dilemmas. Oncogeriatric patients are underrepresented or excluded from clinical trials, especially in the field of surgery, resulting in a lack of evidencebased knowledge regarding their preoperative evaluation, treatment and follow-up. We therefore outline here a framework for the decision-making process, based on recognition of the problem, clarification of the relevant terms, and delineation of the challenges that need to be overcome in designing a meaningful, successful treatment plan for the elderly patient with cancer.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.


  1. 1.

    The United Nations 2014. World population aging report, accesed in 2017 November 25. Available from:

  2. 2.

    The United Nations. Ageing. Accessed 2019 April 6. Available from:

  3. 3.

    Wildiers H, Heeren P, Puts M, et al. International Society of Surgical Oncology Consensus on Geriatric Assessment in Older Patients with Cancer. J Clin Oncol 2014;20;32:2595–603.

  4. 4.

    Montroni I, Audisio RA. Precision surgery for older cancer patients. G Chir 2017;38:59–60.

  5. 5.

    Pedersen JK, Engholm G, Skytthe A, et al. Cancer and aging: Epidemiology and methodological challenges. Acta Oncol 2016; 55(suppl1):7–12.

  6. 6.

    Schlitzkus LL, Melin AA, Johanning JM, et al. Perioperative management of elderly patients. Surg Clin North Am 2015;95:391–415.

  7. 7.

    Audisio RA, Ramesh H, Longo WE, et al. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist 2005;10:262–8.

  8. 8.

    Colloca G, Monfardini S. A contribution to the future of geriatric oncology training: The SIOG Treviso advanced course. J Geriatric Oncol 2017;8:387–8.

  9. 9.

    Michel JP, Huber P, Cruz-Jentoft, et al. Europe wide survey of teaching geriatric medicine. J Am Geriatr Soc 2008;56:5636–42.

  10. 10.

    Masud T, Blundell A, Gordon LA, et al. European undergraduate curriculum in geriatric medicine developed using an international Delphi technique. Age Ageing 2014;43:695–702.

  11. 11.

    Saur NM, Montroni I, Ghignone F, et al. Atittudes of surgeon toward elderly cancer patients: A survey from the SIOG Surgical Task force. Visc Med 2017;33:262–6.

  12. 12.

    Spiliotis J, Tepetes K. Cancer surgery in the elderly. 1st ed. New York: Nova biomedical; c2011.

  13. 13.

    Kowdley GP, Merchant N, Richardson JP, et al. Cancer Surgery in the elderly. ScientificWorld Journal 2012;2012:303852.

  14. 14.

    Orimo H, Suzuki T, Araki A, et al. Reviewing the definition of “elderly”. Geriatr Gerontol Int 2006;6:149–56.

  15. 15.

    Hepworth M. Stories of ageing. Buckinham Phladelphia. Open University Press; c2000.

  16. 16.

    Korc-Grodzicki B, Downey RJ, Shahrokni A, et al. Surgical Considerations in older adults with cancer. J Clin Oncol 2014;32:2647–53.

  17. 17.

    Tremblay D, Charlebois K, Terret C, et al. Integrated oncogeriatric approach: A systematic review using concept analysis. BMJ Open 2012;2:e001483.

  18. 18.

    Swaminathan V, Audisio RA. Cancer in older patients. An analysis of elderly oncology. Ecancermedicalscience 2012;6:243.

  19. 19.

    Hall DE, Arya S, Schmid KK, et al. Association of a frailty screening initiative with postoperative survival at 30, 180 and 365 days. JAMA Surg 2017;152:233–40.

  20. 20.

    Dunn GP. Schared decision making for the elderly patient with a surgical condition. Br J Surg 2016;103:e19–20.

  21. 21.

    Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol 2001;56;3:146–56.

  22. 22.

    Morley JE, Vellas B, Abellan van Kan G, et al. Frailty Consensus: A call for action. J Am Med Dir Assoc 2013;14:392–7.

  23. 23.

    Dent E, Jowal P, Hoogendijk EO. Frailty measurement in research and clinical praxis. Eur J Intern Med 2016;31:3–10.

  24. 24.

    Ali S, Garcia JM. Sarcopenia, cachexia and aging: Diagnosis mechanisms and therapeutic options. Gerontology 2014;60:294–305.

  25. 25.

    Audisio RA. Tailoring surgery to the elderly patients with cancer. Br J Surg 2016;103:e10–11

  26. 26.

    Søreide K, Wijnhoven B. Surgery for the aging population. Br J Surg 2016;103:e7–9.

  27. 27.

    Feng MA, McMillan TD, Crowell K, et a. Geriatric assessment in surgical oncology: A systematic review. J Surg Res 2015;193:265–72.

Download references

Author information

Correspondence to Dimitris Papagoras.

Additional information

Conflict of Interest:

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Papagoras, D., Kanara, M. & Stella, N. Framing the Preoperative Assessment of the Oncogeriatric Patient. The Surgeon’s Point of View. Hellenic J Surg 91, 129–132 (2019).

Download citation


  • Oncogeriatric patients
  • preoperative assessment
  • decision-making process