The value of knowing the whole person in geriatric oncology

Two recent scientific papers about optimal treatment of older patients with cancer not only improve clinical care but also demonstrate Wilmot Cancer Institute’s international leadership in this growing field.

The first journal, ESMO Open, published a position paper reaffirming the value of giving older cancer patients an evaluation known as a “geriatric assessment.”

The tool exposes the diverse conditions of people 70 and older—some can hike mountains, for example, while others are vulnerable and frail—by measuring the health and functional status of the whole person.

Factors include co-morbid conditions like heart disease, high blood pressure or diabetes; medications taken; physical abilities such as walking and maintaining a household; nutrition; psychological condition, social functioning, and family support.

Wilmot member Supriya Mohile, MD, MS, has been a trailblazer in geriatric oncology. She led several large, practice-changing clinical trials in past years showing that geriatric assessments help doctors and older cancer patients make the best personalized treatment decisions. In some cases, studies showed, standard chemotherapy doses can be safely lowered to improve the quality of life in older adults without impacting their survival.

This week, Mohile was senior author on a review article published in CA: A Cancer Journal for Clinicians, with several co-authors from Wilmot, including co-first authors Kah Poh (Melissa) Loh, MBBCh, BAO, MS, and Allison Magnuson, DO.

They noted that geriatric assessments not only reduce cancer treatment toxicity, falls, and potentially harmful drug interactions—they can also reduce health inequities in cancer care for underserved communities.

Loh, who specializes in treating older adults with blood cancers, also led the ESMO/International Society of Geriatric Oncology (SIOG) position paper and is corresponding author. The group considered the most recent evidence and concluded:

• Geriatric assessments are crucial for patients ages 70 and older and, in some cases, should be used for patients in their 60s.
• Geriatric assessments should be performed as early as possible.
• Geriatric assessments can be tailored for different clinical settings, such as community oncology practices versus an academic medical center, and for a variety of health care professionals.
• Re-assessment at intervals during a person’s treatment cycle can indicate changes in course and other supportive care options.

Research is ongoing to evaluate biomarkers of aging to predict health outcomes; exploring other models of geriatric assessments for specific cancer subtypes; and how to effectively leverage technology (wearable devices, telehealth, and mobile apps) to aid older adults who need supportive cancer care.