Dr Lucy Dumas   

Presentation Roadmap/ Summary

The older adult population is heterogeneous. This session will demonstrate that identifying those patients at higher risk of cancer treatment related toxicity and poorer survival outcomes, allows for improved patient-centred decision-making, reducing the risk of over or under-treatment.  Geriatric assessment is a holistic, ideally multidisciplinary diagnostic process to identify care needs, plan care and improve outcomes of frail older people.  Nutritional assessment is an essential component of a geriatric assessment and has been shown to be consistently associated with poorer treatment related and survival outcomes.  Sarcopenia (the loss of muscle mass, quality and strength) is more common with increasing age and frailty and is associated with poorer cancer survival outcomes in a number of different malignancies.  It is attractive both as a clinical marker and as a future direction for research given it is readily measurable using cross-sectional imaging and clinical techniques.  Moreover, there is evidence that sarcopenia is reversible and thus developing our understanding of the inter-relationships between frailty, nutrition and saropenia is essential to develop approaches to address this increasingly relevant condition.

Learning Objectives

At the conclusion of the presentation, the participant will understand that:

1. Older adults, particularly those with age-related medical conditions and/or frailty are more vulnerable during cancer treatment. 
2. Conditions associated with ageing such as frailty and sarcopenia are associated with poorer treatment tolerance and survival outcomes
3. The older adult population is heterogenous, traditional methods of assessment such as ECOG performance status are a limited tool in older patients potentially contributing to increased risk of over or under-treatment.
4. Geriatric assessment can identify vulnerabilities that are not routinely captured in oncology assessment, crucially, addressing areas of concern identified may improve cancer outcomes in older patients.

Key Takeaways/ Fast Facts

• Sarcopenia (the loss of muscle mass, quality and strength) is more common with increasing age and frailty and is associated with poorer cancer survival outcomes in a number of different malignancies. 
• The older adult population is heterogenous, traditional methods of assessment such as ECOG performance status are a limited tool in older patients potentially contributing to increased risk of over or under-treatment.
• Nutritional assessment is an essential component of a geriatric assessment and has been shown to be consistently associated with poorer treatment related and survival outcomes. 

Key references

1. Soubeyran, P., et al., Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol, 2012. 30(15): p. 1829-34.
2. Handforth, C., et al., The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol, 2015. 26(6): p. 1091-101.
3. Bruijnen, C.P., et al., Predictive value of each geriatric assessment domain for older patients with cancer: A systematic review. J Geriatr Oncol, 2019.
4. Martin, L., et al., Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol, 2013. 31(12): p. 1539-47.
5. Cruz-Jentoft, A.J., et al., Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019. 48(1): p. 16-31.
6. Wildiers, H., et al., International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol, 2014. 32(24): p. 2595-603.
7. Mohile, S.G., et al., Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol, 2018. 36(22): p. 2326-2347.