Lazzaro Repetto UOC Oncologia Istituto Nazionale Ricovero e Cura Anziani Istituto di Ricovero e Cura a Carattere Scientifico, Roma Cancer in the older person 4th ESO-EONS Masterclass in Oncology Nursing 2-7 April 2011 Ermatingen (Lake Constance), Switzerland
How to define a Senior Adult in oncology/hematology?
How to evaluate patients and plan for treatment?
Where are we going with geriatric evaluation in oncology/hematology?
As a guide, two ages are important milestones: 70 years because the prevalence of age-related changes strongly increases 85 years because the prevalence of frailty strongly increases There is No Short Definition of Elderly Cancer Patients Do these age limits fit requirements of onco-hematologist ?
CGA is especially beneficial for frail individuals.
Frail Cancer patients have an approximately 50% risk for mortality at 2 years.
We lack data on frailty assessment in cancer pts.
Commonly observed geriatric syndromes GER. SYNDROMES CLINICAL DESCRIPTION Delirium Delirium is a transient organic mental syndrome of acute onset, characterized by global impairment of cognitive functions, reduced level of consciousness, attention abnormalities, increased or decreased psychomotor activity and a disordered sleep-wake cycle. Falls A fall is a sudden, unintentional change in position causing an individual to land at a lower level, for example on an object, floor or ground, that is not consequence of a sudden onset of paralysis, epileptic seizure, or overwhelming external force. Frailty According to phenotypic definition, frailty is defined as the presence of > 3 of 5 components: muscle weakness and slow walking speed, exhaustion, low physical activity, and unintentional weight loss. The definition of frailty based on frailty index (FI) is based on deficit accumulation using 70 deficits from clinical examination . Dizziness Painless head discomfort with many causes including disturbances of vision, brain, balance (vestibular) system of the inner ear, and gastrointestinal system. Dizziness is a medically indistinct term used to describe a variety of conditions ranging from lightheadedness, unsteadiness to vertigo . Urinary incontinence The inability to control urination or bladder control. The severity of urinary incontinence ranges from occasionally leaking urine to unpredictable episodes of strong urinary urgency. Syncope Partial or complete loss of consciousness with a temporary interruption of awareness of oneself and ones surroundings.
IV. Geriatric syndrome of Frailty in Older Cancer Patients
The term frailty is frequently used to describe patients:
in poor overall health,
vulnerable to the effects of environmental stressors,
at high risk for worsened morbidity, disability, and mortality.
Frailty may be present in apparently healthy persons and become evident following a destabilizing event that exceeds a critical stress threshold:
surgery, chemotherapy, etc.
Fisher AL. J Am Geriatr Soc. 2005 - Hogan DB, et al. Aging Clin Exp Res 2003 - Chin A, et al. J Clin Epidemiol. Canadian Study of Health and Aging Working Group. Int Psychogeriatr. 2001.
Usefulness of frailty markers in the assessment of the health and functional status of older cancer patients referred for chemotherapy: a pilot study. Retornaz F, et al. J Gerontol A Biol Sci Med Sci. 2008: 63(5):518-22
Assessing 7 frailty markers ( nutrition, mobility, strength, energy, physical activity, mood and cognition ) , 88% of older cancer pts (>70 yrs) had at least one altered marker and were considered potentially vulnerable.
The use of frailty markers allows to detect functional dependency among older cancer patients without any ADL or IADL deficiency.
We need a better definition of frailty and more reliable tools to categorize cancer pts and to predict adverse outcomes.
age >73yrs, cancer type, standard dose, polychemotherapy, falls in the last 6 months, IADL disability and decreased social activity.
This tool, based on the number of risk factors (1 to 7), predicts the risk of severe chemotherapy related toxicity from 23% to 100%.
Hurria ASCO annual meeting 2010
Prognostic and Predictive Potentials of CGA in older cancer patients.
To assess the individual risk of severe toxicity from cht ( defined by CTC v. 3.0., as Gr. 4 hemat. or Gr. 3-4 non-hemat. tox) in older pts with diverse health conditions and functional reserve measured by CGA.