Abstract
Colorectal cancer is the third most commonly diagnosed cancer worldwide and the second leading cause of death among all malignancies. Despite advances in colorectal cancer screening, the number of deaths has increased. Given that the incidence of colorectal cancer increases with age, it’s important to tailor treatment to this population with special needs. Here we discuss how to incorporate frailty, rather than age, to assess perioperative outcomes. To this end, several useful scoring systems that can easily be incorporated into general practice have been developed. In addition, chemotherapy risk calculators such as CARG or G8 can help predict the likelihood of chemotherapy toxicity in older patients. Focused geriatric assessment in patients with colorectal cancer is associated with improved outcomes such as a decrease in the incidence of chemotherapy toxicity and decreased risk of falls. Overall, geriatricians are an important part of the oncological treatment course and can advocate for their patients to receive tailored treatments to their functional status rather than their age alone.
References
Pilleron S, et al. Global cancer incidence in older adults, 2012 and 2035: a population-based study. Int J Cancer. 2019;144(1):49–58.
Lentz R, Benson AB, Kircher S. Financial toxicity in cancer care: prevalence, causes, consequences, and reduction strategies. J Surg Oncol. 2019;120(1):85–92.
Hofmarcher T, et al. The cost of cancer in Europe 2018. Eur J Cancer. 2020;129:41–9.
Gordon LG, et al. A systematic review of financial toxicity among cancer survivors: we can’t pay the co-pay. Patient. 2017;10(3):295–309.
Park J, Look KA. Health care expenditure burden of cancer care in the United States. Inquiry. 2019;56:46958019880696.
Smith GL, et al. Financial burdens of cancer treatment: a systematic review of risk factors and outcomes. J Natl Compr Cancer Netw. 2019;17(10):1184–92.
Kanesvaran R, et al. The globalization of geriatric oncology: from data to practice. Am Soc Clin Oncol Educ Book. 2020;40:1–9.
Soto-Perez-de-Celis E, et al. Global geriatric oncology: achievements and challenges. J Geriatr Oncol. 2017;8(5):374–86.
Soto-Perez-de-Celis E. Global geriatric oncology: one size does not fit all. J Geriatr Oncol. 2019;10(2):199–201.
Lakhanpal R, et al. Geriatric assessment of older patients with cancer in Australia – a multicentre audit. J Geriatr Oncol. 2015;6(3):185–93.
Manceau G, et al. Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients: a systematic review. Lancet Oncol. 2012;13(12):e525–36.
Chen HL, et al. Effect of age on breast cancer patient prognoses: a population-based study using the SEER 18 database. PLoS One. 2016;11(10):e0165409.
Zeng C, et al. Disparities by race, age, and sex in the improvement of survival for major cancers: results from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program in the United States, 1990 to 2010. JAMA Oncol. 2015;1(1):88–96.
Nipp R, et al. Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer. Cancer Med. 2018;7(2):525–35.
Tan E, et al. Postoperative outcomes in elderly patients undergoing pancreatic resection for pancreatic adenocarcinoma: a systematic review and meta-analysis. Int J Surg. 2019;72:59–68.
Buisman FE, et al. Predicting 10-year survival after resection of colorectal liver metastases; an international study including biomarkers and perioperative treatment. Eur J Cancer. 2022;168:25–33.
Elfrink AKE, et al. Short-term postoperative outcomes after liver resection in the elderly patient: a nationwide population-based study. HPB (Oxford). 2021;23(10):1506–17.
Baijal P, Periyakoil V. Understanding frailty in cancer patients. Cancer J. 2014;20(5):358–66.
Collard RM, et al. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–92.
Chamberlain AM, et al. Frailty Trajectories in an Elderly Population-Based Cohort. J Am Geriatr Soc. 2016;64(2):285–92.
Ofori-Asenso R, et al. Global incidence of frailty and prefrailty among community-dwelling older adults: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(8):e198398.
Shahrokni A, Alexander K. The age of talking about age alone is over. Ann Surg Oncol. 2019;26(1):12–4.
Khan SS, Singer BD, Vaughan DE. Molecular and physiological manifestations and measurement of aging in humans. Aging Cell. 2017;16(4):624–33.
López-Otín C, et al. The hallmarks of aging. Cell. 2013;153(6):1194–217.
Korc-Grodzicki B, Holmes HM, Shahrokni A. Geriatric assessment for oncologists. Cancer Biol Med. 2015;12(4):261–74.
Borson S, et al. The Mini-Cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc. 2003;51(10):1451–4.
Creavin ST, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016;2016(1):CD011145.
Hamaker ME, Wildes TM, Rostoft S. Time to stop saying geriatric assessment is too time consuming. J Clin Oncol. 2017;35(25):2871–4.
Shahrokni A, et al. Electronic rapid fitness assessment: a novel tool for preoperative evaluation of the geriatric oncology patient. J Natl Compr Cancer Netw. 2017;15(2):172–9.
Hurria A, et al. Reliability, validity, and feasibility of a computer-based geriatric assessment for older adults with cancer. J Oncol Pract. 2016;12(12):e1025–34.
McCleary NJ, et al. Feasibility of computer-based self-administered cancer-specific geriatric assessment in older patients with gastrointestinal malignancy. Oncologist. 2013;18(1):64–72.
Guerard E, et al. Electronic geriatric assessment: is it feasible in a multi-institutional study that included a notable proportion of older African American patients? (Alliance A171603). JCO Clin Cancer Inform. 2021;5:435–41.
Cuadra A, et al. The association between perioperative frailty and ability to complete a web-based geriatric assessment among older adults with cancer. Eur J Surg Oncol. 2023;49(3):662–6.
Cuadra A, et al. Introducing the v-RFA, a voice assistant-based geriatric assessment. J Geriatr Oncol. 2022;13(8):1253–5.
Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433–41.
Fried LP, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.
Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011;27(1):17–26.
Shahrokni A, et al. Geriatric assessment, not ASA physical status, is associated with 6-month postoperative survival in patients with cancer aged ≥75 years. J Natl Compr Cancer Netw. 2019;17(6):687–94.
Cohen HJ, et al. Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy. Cancer. 2016;122(24):3865–72.
de Vries J, et al. Association of deficits identified by geriatric assessment with deterioration of health-related quality of life in patients treated for head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2021;147(12):1089–99.
Kenig J, et al. Cumulative deficit model of geriatric assessment to predict the postoperative outcomes of older patients with solid abdominal cancer. J Geriatr Oncol. 2015;6(5):370–9.
Clough-Gorr KM, et al. Older breast cancer survivors: geriatric assessment domains are associated with poor tolerance of treatment adverse effects and predict mortality over 7 years of follow-up. J Clin Oncol. 2010;28(3):380–6.
Hamaker ME, et al. Baseline comprehensive geriatric assessment is associated with toxicity and survival in elderly metastatic breast cancer patients receiving single-agent chemotherapy: results from the OMEGA study of the Dutch breast cancer trialists’ group. Breast. 2014;23(1):81–7.
Apóstolo J, et al. Predicting risk and outcomes for frail older adults: an umbrella review of frailty screening tools. JBI Database System Rev Implement Rep. 2017;15(4):1154–208.
Huisingh-Scheetz M, Walston J. How should older adults with cancer be evaluated for frailty? J Geriatr Oncol. 2017;8(1):8–15.
Fagard K, et al. The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: a systematic review. J Geriatr Oncol. 2016;7(6):479–91.
Boakye D, et al. Impact of comorbidity and frailty on prognosis in colorectal cancer patients: a systematic review and meta-analysis. Cancer Treat Rev. 2018;64:30–9.
Ethun CG, et al. Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA Cancer J Clin. 2017;67(5):362–77.
Handforth C, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2015;26(6):1091–101.
Abel GA, Klepin HD. Frailty and the management of hematologic malignancies. Blood. 2018;131(5):515–24.
Di Donato V, et al. Preoperative frailty assessment in patients undergoing gynecologic oncology surgery: a systematic review. Gynecol Oncol. 2021;161(1):11–9.
Shaw JF, et al. The association of frailty with outcomes after cancer surgery: a systematic review and metaanalysis. Ann Surg Oncol. 2022;29(8):4690–704.
Tsiouris A, et al. A modified frailty index to assess morbidity and mortality after lobectomy. J Surg Res. 2013;183(1):40–6.
Vermillion SA, et al. Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol. 2017;115(8):997–1003.
Hodari A, et al. Assessment of morbidity and mortality after esophagectomy using a modified frailty index. Ann Thorac Surg. 2013;96(4):1240–5.
Di Donato V, et al. Modified fragility index and surgical complexity score are able to predict postoperative morbidity and mortality after cytoreductive surgery for advanced ovarian cancer. Gynecol Oncol. 2021;161(1):4–10.
Feng MA, et al. Geriatric assessment in surgical oncology: a systematic review. J Surg Res. 2015;193(1):265–72.
Mandelblatt JS, et al. Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance). Breast Cancer Res Treat. 2017;164(1):107–17.
Hurria A, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457–65.
Hurria A, et al. Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol. 2016;34(20):2366–71.
Magnuson A, et al. Development and validation of a risk tool for predicting severe toxicity in older adults receiving chemotherapy for early-stage breast cancer. J Clin Oncol. 2021;39(6):608–18.
Extermann M, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118(13):3377–86.
Skelly A, O’Donovan A. Recognizing frailty in radiation oncology clinical practice: current evidence and future directions. Semin Radiat Oncol. 2022;32(2):115–24.
Gilmore N, et al. Evaluating the association of frailty with communication about aging-related concerns between older patients with advanced cancer and their oncologists. Cancer. 2022;128(5):1101–9.
Rosa WE, et al. Geriatrics communication skills training program for oncology healthcare providers to improve the management of care for older adults with cancer. PEC Innov. 2022;1:100066.
Rector T, et al. Life expectancy calculators. Washington, DC: Department of Veterans Affairs; 2016.
Verduzco-Aguirre HC, et al. Predicting life expectancy for older adults with cancer in clinical practice: implications for shared decision-making. Curr Oncol Rep. 2019;21(8):68.
Lee SJ, et al. Development and validation of a prognostic index for 4-year mortality in older adults. JAMA. 2006;295(7):801–8.
Marcucci M, et al. Interventions to prevent, delay or reverse frailty in older people: a journey towards clinical guidelines. BMC Med. 2019;17(1):193.
Cesari M, et al. The geriatric management of frailty as paradigm of “The end of the disease era”. Eur J Intern Med. 2016;31:11–4.
Mohile SG, et al. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. J Clin Oncol. 2018;36(22):2326–47.
Mohile SG, et al. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet. 2021;398(10314):1894–904.
Montroni I, et al. Surgical considerations for older adults with cancer: a multidimensional, multiphase pathway to improve care. J Clin Oncol. 2021;39(19):2090–101.
Hijazi Y, Gondal U, Aziz O. A systematic review of prehabilitation programs in abdominal cancer surgery. Int J Surg. 2017;39:156–62.
Briggs LG, et al. Prehabilitation exercise before urologic cancer surgery: a systematic and interdisciplinary review. Eur Urol. 2022;81(2):157–67.
Trevino KM, et al. Is screening for psychosocial risk factors associated with mental health care in older adults with cancer undergoing surgery? Cancer. 2020;126(3):602–10.
Nasreddine ZS, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.
Joly F, et al. Impact of cancer and its treatments on cognitive function: advances in research from the paris international cognition and cancer task force symposium and update since 2012. J Pain Symptom Manag. 2015;50(6):830–41.
Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28(3):e49–55.
Eamer G, et al. Comprehensive geriatric assessment for older people admitted to a surgical service. Cochrane Database Syst Rev. 2018;1(1):CD012485.
Van Heghe A, et al. Effects of orthogeriatric care models on outcomes of hip fracture patients: a systematic review and meta-analysis. Calcif Tissue Int. 2022;110(2):162–84.
Filippova OT, et al. Geriatric co-management leads to safely performed cytoreductive surgery in older women with advanced stage ovarian cancer treated at a tertiary care cancer center. Gynecol Oncol. 2019;154(1):77–82.
Shahrokni A, et al. Association of geriatric comanagement and 90-day postoperative mortality among patients aged 75 years and older with cancer. JAMA Netw Open. 2020;3(8):e209265.
McMillan S, et al. Association of frailty with 90-day postoperative mortality & geriatric comanagement among older adults with cancer. Eur J Surg Oncol. 2022;48(4):903–8.
Giannotti C, et al. Effect of geriatric comanagement in older patients undergoing surgery for gastrointestinal cancer: a retrospective, before-and-after study. J Am Med Dir Assoc. 2022;23(11):1868.e9–1868.e16.
Letica-Kriegel AS, et al. Feasibility of a geriatric comanagement (GERICO) pilot program for patients 75 and older undergoing radical cystectomy. Eur J Surg Oncol. 2022;48(6):1427–32.
Cooper L, et al. Launching a geriatric surgery center: recommendations from the society for perioperative assessment and quality improvement. J Am Geriatr Soc. 2020;68(9):1941–6.
Li D, et al. Geriatric Assessment-Driven Intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: a randomized clinical trial. JAMA Oncol. 2021;7(11):e214158.
Soo WK, et al. Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in older people with cancer starting systemic anticancer treatment in Australia: a multicentre, open-label, randomised controlled trial. Lancet Healthy Longev. 2022;3(9):e617–27.
Jolly TA, et al. A randomized trial of real-time geriatric assessment reporting in nonelectively hospitalized older adults with cancer. Oncologist. 2020;25(6):488–96.
Puts M, et al. Impact of geriatric assessment and management on quality of life, unplanned hospitalizations, toxicity, and survival for older adults with cancer: the randomized 5C trial. J Clin Oncol. 2023;41(4):847–58.
Nipp RD, et al. Effects of a perioperative geriatric intervention for older adults with Cancer: a randomized clinical trial. J Geriatr Oncol. 2022;13(4):410–5.
Shrestha A, et al. Quality of life versus length of life considerations in cancer patients: A systematic literature review. Psychooncology. 2019;28(7):1367–80.
Seghers PALN, et al. Patient preferences for treatment outcomes in oncology with a focus on the older patient-a systematic review. Cancers (Basel). 2022;14(5):1147.
DuMontier C, et al. Decision making in older adults with cancer. J Clin Oncol. 2021;39(19):2164–74.
Tinetti ME, et al. Outcome goals and health care preferences of older adults with multiple chronic conditions. JAMA Netw Open. 2021;4(3):e211271.
Torres-Guzman RA, et al. Smartphones and threshold-based monitoring methods effectively detect falls remotely: a systematic review. Sensors (Basel). 2023;23(3):1323.
Beauchamp UL, Pappot H, Holländer-Mieritz C. The use of wearables in clinical trials during cancer treatment: systematic review. JMIR Mhealth Uhealth. 2020;8(11):e22006.
Moore K, et al. Older adults’ experiences with using wearable devices: qualitative systematic review and meta-synthesis. JMIR Mhealth Uhealth. 2021;9(6):e23832.
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Shahrokni, A., Pozdniakova, H., Nightingale, B. (2024). Cancer and Older Adults: The Introduction. In: Wasserman, M.R., Bakerjian, D., Linnebur, S., Brangman, S., Cesari, M., Rosen, S. (eds) Geriatric Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-74720-6_123
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