Geriatric Oncology: Past, Present, Future
01 Jul 2008-Journal of Oncology Practice (American Society of Clinical Oncology)-Vol. 4, Iss: 4, pp 190-192
TL;DR: Efforts to integrate geriatric oncology principles in the training of all medical oncologists are underway.
Abstract: Efforts to integrate geriatric oncology principles in the training of all medical oncologists are underway.
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TL;DR: A study in this issue of the Journal of Oncology Practice (JOP) highlights the numerous remaining barriers to participation of the elderly in early phase cancer clinical trials, as well as the need to develop a core geriatric oncology curriculum for conventional hematology-oncology training.
Abstract: Cancer is primarily a disease of aging representing the leading cause of death for both men and women between 60 and 80 years of age.1 In fact, increasing age, undoubtedly, represents the strongest risk factor for developing cancer.2 In addition to the millions of cancer survivors living into their later years, it is estimated that nearly one in three septuagenarians will develop a new cancer diagnosis during the remainder of their lives.1 In addition to the impact of the disease on affected patients and their families, there is a considerable societal cost associated with cancer in elderly individuals. Investigators at the National Cancer Institute have recently estimated the aggregate 5-year net direct costs of cancer care to Medicare at more than $21 billion.3 Such figures, however, do not reflect the enormous nonmedical, indirect and out-of-pocket expenses for cancer care which have been estimated to equal or exceed these numbers.4
Figure 1
Gary H. Lyman, MD, MPH, FRCP(Edin)
While there has been an encouraging decrease in cancer-related mortality among younger patients, the same trend has not been observed in the very elderly. Until recently, most clinical trials systematically excluded elderly cancer patients. While considerable progress has been made in addressing such selection bias, particularly by the major cancer cooperative groups, a study in this issue of the Journal of Oncology Practice (JOP) by Basche et al, and elegantly discussed in the accompanying commentary by Cohen highlights the numerous remaining barriers to participation of the elderly in early phase cancer clinical trials.5,6 These concerns, as well as the rapid increase in the proportion of the population older than the age of 65, has spawned professional societies, textbooks, guidelines, and an enormous volume of research and resulting publications addressing a broad range of issues related to cancer in older patients with cancer.7–9 A search of the National Library of Medicine Medline database reveals nearly half a million citations on cancer in the elderly. JOP recently devoted an entire issue to the topic of geriatric oncology.2
At the same time, there has also been considerable discussion about the appropriate preparation of medical specialists, including oncologists, in the specialized needs of the rapidly growing elderly population with cancer. The past decade has witnessed the emergence of subspecialty tracks in geriatric oncology with concentrated training of a limited number of individuals in both medical oncology and geriatrics. Formal training programs were developed at a number of major centers fostered largely by efforts of the American Society of Clinical Oncology (ASCO) and funded by the Hartford Foundation. While these programs focus considerable attention on the specialized needs of the older patient with cancer, it has always been clear that the majority of elderly patients with cancer will continue to be cared for by medical oncologists in practice. As pointed out in the accompanying article by Rao et al in this issue of JOP, both the Accreditation Council for Graduate Medical Education (ACGME) in their guidelines for adult hematology-oncology fellowships and the American Board of Internal Medicine in recent board certification examinations have devoted increasing attention to the education and evaluation of oncologists in the specialized challenges and appropriate management of the older patient with cancer.10 It is noted, however, that trainees in hematology-oncology at most institutions still complete their fellowship without formal training in the care of older patients with cancer.
The article by Rao et al presents the conclusions and recommendations of a 2-day consensus conference funded by the Donald W. Reynolds Foundation held at Duke University, and aimed at developing a strategy for developing a core curriculum in geriatric oncology for medical oncology training programs. In addition to surveying current fellowship program directors and previous fellows completing formal geriatric oncology training, funding is being sought for a large conference including the above individuals and other thought leaders in the field to develop a core geriatric oncology curriculum for integration into conventional hematology-oncology training. Key curriculum areas that should be incorporated into fellowship training include the appropriate management of both solid and hematologic malignancies in older patients, the biology of cancer and aging, the pharmacology of cancer therapies in the elderly, and training in comprehensive geriatric assessment and methods of providing optimal supportive care to such patients. As discussed in the last issue of JOP, the elderly patient presents recognized challenges to and opportunities for the delivery of optimal cancer treatment.11,12
With the support and guidance of professional organizations, such as ASCO and ACGME, as well as concerned philanthropy from such organizations as the Hartford and Reynolds Foundations, the goals and objectives put forward in the consensus statement can become reality. The appropriate and comprehensive training of the next generation of oncologists must represent a high priority for the entire profession culminating in greater awareness and appreciation among future cancer specialists of the pervasive yet very special needs of the expanding population of elderly patients with cancer.
5 citations
Dissertation•
14 Jan 2014
1 citations
Cites background from "Geriatric Oncology: Past, Present, ..."
...Telomere length has also been proposed as a biomarker of ageing, as it appears to predict lifespan.(51,52) The rate at which telomeres wear down varies between people and can depend on environmental stimuli (e....
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25 Jan 2017
TL;DR: This paper presents a meta-analyses of the determinants of infectious disease in eight operation rooms over a 12-month period and shows clear patterns of decline in the number of infections and in the severity of the diseases investigated.
Abstract: .................................................................................................... 5 1. Background ............................................................................................ 6 2. Methods ................................................................................................. 7 3. Findings ................................................................................................. 8 4. Discussion and Conclusions ................................................................. 13 TABLES AND FIGURES .................................................................................. 16 REFERENCES ................................................................................................ 38
1 citations
01 Jan 2013
TL;DR: Data from subgroups of elderly patients informs clinicians of the utility and toxicity profiles of chemotherapy and the pharmacological characteristics of the commonly used chemotherapeutic agents are further explored.
Abstract: Chemotherapy is a key component of treatment of women with epithelial ovarian cancer regardless of age. Increasing comorbidities and changes in drug pharmacodynamics and pharmacokinetics with increasing age can lead to increased toxicity. The assessment of renal function is vital for accurate dosing of renally excreted agents such as carboplatin. While data from clinical trials specifically in older adults is limited, data from subgroups of elderly patients informs clinicians of the utility and toxicity profiles of chemotherapy. The pharmacological characteristics of the commonly used chemotherapeutic agents are further explored.
TL;DR: The Geriatric Oncology Cognition and Communication (Geri-Onc CC) training program as mentioned in this paper was developed and implemented for healthcare professionals to meet the unique needs of older adults with cancer and their families.
References
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TL;DR: In this paper, it has been stated in this article and elsewhere that cancer patients aged 65 years and older deserve special attention as a target group for research efforts across the cancer-control spectrum.
Abstract: It has been stated in this article and elsewhere that cancer patients aged 65 years and older deserve special attention as a target group for research efforts across the cancer-control spectrum. The available data show that the vulnerability of older persons to cancer is unmistakable. Clinicians will be treating more older patients as the nation ages. The future needs of this segment of the population must be anticipated. In this context, the following generic treatment questions are pertinent. What are the peculiarities of the aged host of which clinicians must be aware in evaluating the older cancer patient? Do various forms of cancer present differently in the elderly? How can be complications caused by the multiple pathologies inherent in the older patient be anticipated? What are the potential hazards and limitations of surgery, radiotherapy, and chemotherapy for older persons with cancer? What is known regarding increased risk of adverse reactions to medications, drugs, and interaction of drugs in older patients? The surveillance data and population estimates and projections presented in this article illustrate the extent of the problems of cancer in the elderly at the macro level. For the individual patient, the special knowledge of aging individuals and their health status based on geriatric medicine and gerontology that has been accumulating for the past several decades needs to be incorporated into the oncology armamentarium that has developed during the same period. The information and expertise from both fields must converge, and new knowledge must be developed at the aging/cancer interface and applied for the optimal treatment of cancer in the elderly.
382 citations
TL;DR: Current and future demographic transitions in America in comparison with six industrial nations are illustrated, and cancer mortality in older persons across the selected nations--Denmark, France, Italy, Japan, Sweden, and United Kingdom are profiles.
323 citations
"Geriatric Oncology: Past, Present, ..." refers background in this paper
...... set the tone for further discussions and research in this area.4 This conference was attended by now-known pioneers in the field of geriatric oncology, who addressed a number of important issues, including: (1) existing discrepancies between physiologic and chronologic age; (2) changes in age structure of the nation’s population and cancer control in the elderly; (3) the role of cancer prevention and treatment in older adults; and ( 4 ) ......
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TL;DR: Clinical trials need to incorporate an analysis of chemotherapy in terms of the pharmacokinetic and pharmacodynamic effects of aging, and data already accumulated need to be reanalyzed by age to aid in the management of the older cancer patient.
Abstract: The elderly comprise the majority of patients with cancer and are the recipients of the greatest amount of chemotherapy. Unfortunately, there is a lack of data to make evidence-based decisions with regard to chemotherapy. This is due to the minimal participation of older patients in clinical trials and that trials have not systematically evaluated chemotherapy. This article reviews the available information with regard to chemotherapy and aging provided by a task force of the International Society of Geriatric Oncology (SIOG). Due to the lack of prospective data, the conclusions and recommendations made are a consensus of the participants. Extrapolation of data from younger to older patients is necessary, particularly to those patients older than 80 years, for which data is almost entirely lacking. The classes of drugs reviewed include alkylators, antimetabolites, anthracyclines, taxanes, camptothecins, and epipodophyllotoxins. Clinical trials need to incorporate an analysis of chemotherapy in terms of the pharmacokinetic and pharmacodynamic effects of aging. In addition, data already accumulated need to be reanalyzed by age to aid in the management of the older cancer patient.
220 citations
Stanford University1, Seattle Cancer Care Alliance2, Harvard University3, University of South Florida4, Roswell Park Cancer Institute5, Ohio State University6, Fox Chase Cancer Center7, Northwestern University8, University of Michigan9, Memorial Sloan Kettering Cancer Center10, University Of Tennessee System11, University of California, San Francisco12, Duke University13, University of Alabama at Birmingham14, University of Nebraska–Lincoln15, City of Hope National Medical Center16, University of Texas MD Anderson Cancer Center17, University of Utah18, Johns Hopkins University19
174 citations
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TL;DR: Physicians and oncologists need to be prepared for the projected increase of cancer in older persons and a new subspecialty is evolving: geriatric oncology.
Abstract: The world's population is aging. Older age is associated with an increase in the incidence of cancer, especially cancer of the breast, lung, prostate, and colon. The management of older patients with cancer is biased by the simple fact of their chronologic age. Underscreening, understaging, less aggressive therapy, lack of participation in clinical trials, or no treatment at all reflect this bias. Although an age-related reduction in the physiologic function of many organs occurs with age, these are not contraindications to treatment with surgery, radiation therapy, or chemotherapy. Chronologic age alone should not be used as a guide for cancer management. Rather, physiologic function or existence of comorbid conditions should be major factors in determining treatment. As a result of the impending need for improved cancer management in older persons, a new subspecialty is evolving: geriatric oncology. This field stresses an important interaction between geriatricians and oncologists, development of research directed at the problems of cancer in older persons, and education at all levels with respect to cancer prevention, cancer detection, and cancer therapy. Physicians and oncologists need to be prepared for the projected increase of cancer in older persons.
148 citations