What to Consider When It Comes to Surgery in Elderly Patients With Cancer

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Dr. Farma provides his insight on treating the elderly patient population in the surgical oncology setting.
Dr. Farma provides his insight on treating the elderly patient population in the surgical oncology setting.

In August, Korc-Grodzicki and colleagues published an intriguing article entitled, “Surgical Considerations in Older Adults With Cancer” in the Journal of Clinical Oncology.1

Their article reviewed salient topics related to risk assessment and perioperative evaluation and management in the treatment of older adults with cancer.

As many of us feel, age is just a number and there are numerous clinical criteria that oncologists should use to evaluate patients with cancer and personalize the best course of action for their care. Korc-Grodzicki and colleagues raise many interesting topics to consider in the elderly patient population.

In the introduction they raise questions that the surgeon must consider when planning treatment in this population of patients including:

• Do we know how to assist them?
• Do we understand their needs?
• Are we able to assess and predict operative risks?

Jeffrey M. Farma, MD
Jeffrey M. Farma, MD

As I have just consented a 92-year-old male with locally advanced rectal cancer for an abdominoperineal resection, I feel this article provided extremely relevant and timely information.

Korc-Grodzicki and colleagues also bring up the important point that, while oncologists often use an evidence-based approach to medicine, many of the clinical trials that are used to make treatment-related decisions exclude patients older than age 70.

RELATED: Screening for Breast Cancer in Elderly Women Questioned

There are numerous assessment tools, such as the comprehensive geriatric assessment (CGA), and also medical geriatricians who can assist in risk stratification and planning of perioperative needs for these patients. 

“Geriatric surgical patients have unique vulnerabilities that require assessment beyond the traditional preoperative evaluation.”1

Geriatricians use the CGA and its benefits have led to “prolongation of life, prevention of geriatric syndromes, prevention of institutionalization and improvement of subjective well-being.”1 The International Society of Geriatric Oncology recommends CGA use in older patients.

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